Download PDF
Semin Neurol 2015; 35(02): 125-138
DOI: 10.1055/s-0035-1547541
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Ancillary Testing in Brain Death

Andreas H. Kramer
1   Department of Critical Care Medicine and Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
› Author Affiliations
Further Information

Publication History

Publication Date:
03 April 2015 (online)

    Permissions and Reprints

Abstract

Despite worldwide acceptance of the concept of brain death, there is marked variability in the use of ancillary testing. In most countries, ancillary tests are used primarily when confounding factors interfere with reliable completion of a clinical assessment, or physiologic instability precludes performance of an apnea test. Alternatively, in some countries, confirmatory ancillary tests are routinely required before brain death can be diagnosed. Ancillary tests assess brain function (e.g., electroencephalography) or blood flow (e.g., cerebral angiography). Evaluation of blood flow is affected less by confounding clinical factors and is now preferred in most jurisdictions. With angiographic techniques, a significant proportion of patients meeting clinical criteria for brain death have some opacification of proximal intracranial arteries. Consequently, the sensitivity of angiography is strongly influenced by the particular criteria that are used to define intracranial circulatory arrest. Lack of enhancement of the great cerebral and internal cerebral veins has the highest sensitivity. Worldwide experience with newer tests, such as computed tomography and magnetic resonance angiography, is growing. Radionuclide imaging has the advantage of not requiring use of potentially nephrotoxic contrast material. Transcranial Doppler ultrasonography can be brought to the bedside to demonstrate lack of brain blood flow. The specificity of imaging techniques in the detection of intracranial circulatory arrest has not been as well studied as their sensitivity.

Keywords

brain death - ancillary tests - angiography - electroencephalography
 

  • References

  • 1 The Quality Standards Subcommittee of the American Academy of Neurology. Practice parameters for determining brain death in adults (summary statement). Neurology 1995; 45 (5) 1012-1014
    CrossrefPubMedGoogle Scholar
  • 2 Wijdicks EF, Varelas PN, Gronseth GS, Greer DM ; American Academy of Neurology. Evidence-based guideline update: determining brain death in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2010; 74 (23) 1911-1918
    CrossrefPubMedGoogle Scholar
  • 3 Shemie SD, Doig C, Dickens B , et al; Pediatric Reference Group; Neonatal Reference Group. Severe brain injury to neurological determination of death: Canadian forum recommendations. CMAJ 2006; 174 (6) S1-S13
    CrossrefPubMedGoogle Scholar
  • 4 Australian and New Zealand Intensive Care Society. The ANZICS Statement on Death and Organ Donation. Edition 3.2. VIC Australia: New Zealand Intensive Care Society; 2013
    Google Scholar
  • 5 Academy of Medical Royal Colleges. A code of practice for the diagnosis and confirmation of death. London: Academy of Medical Royal Colleges; 2008
    Google Scholar
  • 6 Mollaret P, Goulon M. Le coma dépassé. Rev Neurol (Paris) 1959; 101: 3-15
    PubMedGoogle Scholar
  • 7 Fishgold H, Mathis P. Obnubilations, coma et stupeurs: etudes electroencepahlographiques. Electroencephalogr Clin Neurophysiol 1959; 11: 27-68
    PubMedGoogle Scholar
  • 8 Lofsted S, Von Reis G. Diminution or obstruction of blood flow in the internal carotid artery. Opuse Med 1959; 4: 345-360
    PubMedGoogle Scholar
  • 9 Goodman JM, Mishkin FS, Dyken M. Determination of brain death by isotope angiography. JAMA 1969; 209 (12) 1869-1872
    CrossrefPubMedGoogle Scholar
  • 10 Greitz T, Gordon E, Kolmodin G, Widén L. Aortocranial and carotid angiography in determination of brain death. Neuroradiology 1973; 5 (1) 13-19
    CrossrefPubMedGoogle Scholar
  • 11 A definition of irreversible coma: Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. JAMA 1968; 205 : 205: 337-340
    CrossrefPubMedGoogle Scholar
  • 12 Diagnosis of brain death. Statement issued by the honorary secretary of the Conference of Medical Royal Colleges and their Faculties in the United Kingdom on 11 October 1976. BMJ 1976; 2: 1187-1188
    CrossrefPubMedGoogle Scholar
  • 13 Anonymous. An appraisal of the criteria of cerebral death. A summary statement. A collaborative study. JAMA 1977; 237 (10) 982-986
    CrossrefPubMedGoogle Scholar
  • 14 Guidelines for the determination of death. Report of the medical consultants on the diagnosis of death to the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. JAMA 1981; 246: 2184-2186
    CrossrefPubMedGoogle Scholar
  • 15 Wijdicks EFM. Brain death worldwide: accepted fact but no global consensus in diagnostic criteria. Neurology 2002; 58 (1) 20-25
    CrossrefPubMedGoogle Scholar
  • 16 Citerio G, Crippa IA, Bronco A, Vargiolu A, Smith M. Variability in brain death determination in Europe: looking for a solution. Neurocrit Care 2014; 21 (3) 376-382 Epub ahead of print
    CrossrefPubMedGoogle Scholar
  • 17 Shappell CN, Frank JI, Husari K, Sanchez M, Goldenberg F, Ardelt A. Practice variability in brain death determination: a call to action. Neurology 2013; 81 (23) 2009-2014
    CrossrefPubMedGoogle Scholar
  • 18 Empey PE, Miller TM, Philbrick AH, Melick JA, Kochanek PM, Poloyac SM. Mild hypothermia decreases fentanyl and midazolam steady-state clearance in a rat model of cardiac arrest. Crit Care Med 2012; 40 (4) 1221-1228
    CrossrefPubMedGoogle Scholar
  • 19 Busl KM, Greer DM. Pitfalls in the diagnosis of brain death. Neurocrit Care 2009; 11 (2) 276-287
    CrossrefPubMedGoogle Scholar
  • 20 Saposnik G, Basile VS, Young GB. Movements in brain death: a systematic review. Can J Neurol Sci 2009; 36 (2) 154-160
    CrossrefPubMedGoogle Scholar
  • 21 Datar S, Fugate J, Rabinstein A, Couillard P, Wijdicks EFM. Completing the apnea test: decline in complications. Neurocrit Care 2014; 21 (3) 392-396
    CrossrefPubMedGoogle Scholar
  • 22 Wijdicks EF, Rabinstein AA, Manno EM, Atkinson JD. Pronouncing brain death: contemporary practice and safety of the apnea test. Neurology 2008; 71 (16) 1240-1244
    CrossrefPubMedGoogle Scholar
  • 23 Savard M, Turgeon AF, Gariépy JL, Trottier F, Langevin S. Selective 4 vessels angiography in brain death: a retrospective study. Can J Neurol Sci 2010; 37 (4) 492-497
    CrossrefPubMedGoogle Scholar
  • 24 Yee AH, Mandrekar J, Rabinstein AA, Wijdicks EFM. Predictors of apnea test failure during brain death determination. Neurocrit Care 2010; 12 (3) 352-355
    CrossrefPubMedGoogle Scholar
  • 25 Wijdicks EF, Hijdra A, Young GB, Bassetti CL, Wiebe S ; Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2006; 67 (2) 203-210
    CrossrefPubMedGoogle Scholar
  • 26 Wijdicks EF. The transatlantic divide over brain death determination and the debate. Brain 2012; 135 (Pt 4) 1321-1331
    CrossrefPubMedGoogle Scholar
  • 27 Webb A, Samuels O. Brain death dilemmas and the use of ancillary testing. Continuum (Minneap Minn) 2012; 18 (3) 659-668
    PubMedGoogle Scholar
  • 28 der Bundesarztekammer WB. Richtlinien zur Festsellung des Hirntodes. Dtsch Arztebl 1998; 53: A1861-A1868
    PubMedGoogle Scholar
  • 29 Siminoff LA, Burant C, Youngner SJ. Death and organ procurement: public beliefs and attitudes. Kennedy Inst Ethics J 2004; 14 (3) 217-234
    CrossrefPubMedGoogle Scholar
  • 30 Soldatos T, Karakitsos D, Wachtel M , et al. The value of transcranial Doppler sonography with a transorbital approach in the confirmation of cerebral circulatory arrest. Transplant Proc 2010; 42 (5) 1502-1506
    CrossrefPubMedGoogle Scholar
  • 31 Bernat JL. Controversies in defining and determining death in critical care. Nat Rev Neurol 2013; 9 (3) 164-173
    CrossrefPubMedGoogle Scholar
  • 32 Doig CJ, Burgess E. Brain death: resolving inconsistencies in the ethical declaration of death. Can J Anaesth 2003; 50 (7) 725-731
    CrossrefPubMedGoogle Scholar
  • 33 Greer DM, Varelas PN, Haque S, Wijdicks EF. Variability of brain death determination guidelines in leading US neurologic institutions. Neurology 2008; 70 (4) 284-289
    CrossrefPubMedGoogle Scholar
  • 34 Wijdicks EFM. The case against confirmatory tests for determining brain death in adults. Neurology 2010; 75 (1) 77-83
    CrossrefPubMedGoogle Scholar
  • 35 Morrissey PE, Monaco AP. Donation after circulatory death: current practices, ongoing challenges, and potential improvements. Transplantation 2014; 97 (3) 258-264
    CrossrefPubMedGoogle Scholar
  • 36 American Clinical Neurophysiology Society. Guideline 3: Minimum Technical Standards for EEG Recording in Suspected Cerebral Death. Available at: http://www.acns/org/pdf/guidelines/Guidline-3.pdf . Accessed November 18, 2014
    PubMedGoogle Scholar
  • 37 Young GB, Lee D. A critique of ancillary tests for brain death. Neurocrit Care 2004; 1 (4) 499-508
    CrossrefPubMedGoogle Scholar
  • 38 Brierley JB, Graham DI, Adams JH, Simpsom JA. Neocortical death after cardiac arrest. A clinical, neurophysiological, and neuropathological report of two cases. Lancet 1971; 2 (7724) 560-565
    PubMedGoogle Scholar
  • 39 Blend MJ, Pavel DG, Hughes JR, Tan WS, Lansky LL, Toffol GJ. Normal cerebral radionuclide angiogram in a child with electrocerebral silence. Neuropediatrics 1986; 17 (3) 168-170
    Article in Thieme ConnectPubMedGoogle Scholar
  • 40 Vicenzini E, Pro S, Randi F , et al. Transcranial Doppler for brain death after decompressive craniectomy: persistence of cerebral blood flow with flat EEG. Intensive Care Med 2010; 36 (12) 2163-2164
    CrossrefPubMedGoogle Scholar
  • 41 Rimmelé T, Malhière S, Ben Cheikh A , et al. [The electroencephalogram is not an adequate test to confirm the diagnosis of brain death]. Can J Anaesth 2007; 54 (8) 652-656
    CrossrefPubMedGoogle Scholar
  • 42 Grigg MM, Kelly MA, Celesia GG, Ghobrial MW, Ross ER. Electroencephalographic activity after brain death. Arch Neurol 1987; 44 (9) 948-954
    CrossrefPubMedGoogle Scholar
  • 43 Welschehold S, Boor S, Reuland K , et al. Technical aids in the diagnosis of brain death: a comparison of SEP, AEP, EEG, TCD and CT angiography. Dtsch Arztebl Int 2012; 109 (39) 624-630
    PubMedGoogle Scholar
  • 44 Fernández-Torre JL, Hernández-Hernández MA, Muñoz-Esteban C. Non confirmatory electroencephalography in patients meeting clinical criteria for brain death: scenario and impact on organ donation. Clin Neurophysiol 2013; 124 (12) 2362-2367
    CrossrefPubMedGoogle Scholar
  • 45 Vicenzini E, Pro S, Pulitano P , et al. Current practice of brain death determination and use of confirmatory tests in an Italian University hospital: a report of 66 cases. Minerva Anestesiol 2013; 79 (5) 485-491
    PubMedGoogle Scholar
  • 46 Riishede J, Ethelberg S. Angiographic changes in sudden and severe herniation of brain stem through tentorial incisure; report of five cases. AMA Arch Neurol Psychiatry 1953; 70 (3) 399-409
    CrossrefPubMedGoogle Scholar
  • 47 Pribram HF. Angiographic appearances in acute intracranial hypertension. Neurology 1961; 11: 10-21
    CrossrefPubMedGoogle Scholar
  • 48 Flowers Jr WM, Patel BR. Radionuclide angiography as a confirmatory test for brain death: a review of 229 studies in 219 patients. South Med J 1997; 90 (11) 1091-1096
    CrossrefPubMedGoogle Scholar
  • 49 Walker AE, Diamond EL, Moseley J. The neuropathological findings in irreversible coma. A critque of the “respirator”. J Neuropathol Exp Neurol 1975; 34 (4) 295-323
    CrossrefPubMedGoogle Scholar
  • 50 Wijdicks EFM, Pfeifer EA. Neuropathology of brain death in the modern transplant era. Neurology 2008; 70 (15) 1234-1237
    CrossrefPubMedGoogle Scholar
  • 51 Bradac GB, Simon RS. Angiography in brain death. Neuroradiology 1974; 7 (1) 25-28
    CrossrefPubMedGoogle Scholar
  • 52 Kricheff II, Pinto RS, George AE, Braunstein P, Korein J. Angiographic findings in brain death. Ann N Y Acad Sci 1978; 315: 168-183
    CrossrefPubMedGoogle Scholar
  • 53 Braum M, Ducrocq X, Huot JC, Audibert G, Anxionnat R, Picard L. Intravenous angiography in brain death: report of 140 patients. Neuroradiology 1997; 39 (6) 400-405
    CrossrefPubMedGoogle Scholar
  • 54 Munari M, Zucchetta P, Carollo C , et al. Confirmatory tests in the diagnosis of brain death: comparison between SPECT and contrast angiography. Crit Care Med 2005; 33 (9) 2068-2073
    CrossrefPubMedGoogle Scholar
  • 55 Korein J, Braunstein P, George A , et al. Brain death: I. Angiographic correlation with the radioisotopic bolus technique for evaluation of critical deficit of cerebral blood flow. Ann Neurol 1977; 2 (3) 195-205
    CrossrefPubMedGoogle Scholar
  • 56 Bücheler E, Käufer C. [Carotid and vertebral angiography in brain death]. Acta Radiol Diagn (Stockh) 1972; 13 (1) 301-311
    PubMedGoogle Scholar
  • 57 Nau R, Prange HW, Klingelhöfer J , et al. Results of four technical investigations in fifty clinically brain dead patients. Intensive Care Med 1992; 18 (2) 82-88
    CrossrefPubMedGoogle Scholar
  • 58 Alvarez LA, Lipton RB, Hirschfeld A, Salamon O, Lantos G. Brain death determination by angiography in the setting of a skull defect. Arch Neurol 1988; 45 (2) 225-227
    CrossrefPubMedGoogle Scholar
  • 59 Gomes AS, Hallinan JM. Intravenous digital subtraction angiography in the diagnosis of brain death. AJNR Am J Neuroradiol 1983; 4 (1) 21-24
    PubMedGoogle Scholar
  • 60 Van Bunnen Y, Delcour C, Wery D, Richoz B, Struyven J. Intravenous digital subtraction angiography. A criteria of brain death. Ann Radiol (Paris) 1989; 32 (4) 279-281
    PubMedGoogle Scholar
  • 61 Sinha P, Conrad GR. Scintigraphic confirmation of brain death. Semin Nucl Med 2012; 42 (1) 27-32
    CrossrefPubMedGoogle Scholar
  • 62 Mishkin FS, Dyken ML. Increased early radionuclide activity in the nasopharyngeal area in patients with internal carotid artery obstruction: “hot nose”. Radiology 1970; 96 (1) 77-80
    CrossrefPubMedGoogle Scholar
  • 63 Joffe AR, Lequier L, Cave D. Specificity of radionuclide brain blood flow testing in brain death: case report and review. J Intensive Care Med 2010; 25 (1) 53-64
    CrossrefPubMedGoogle Scholar
  • 64 Singh NC, Reid RH, Loft JA, Frewen TC, Parker BL, Dhillon JS. Usefulness of (Tc 99m) HM-PAO scan in supporting clinical brain death in children: uncoupling flow and function. Clin Intensive Care 1994; 5 (2) 71-74
    PubMedGoogle Scholar
  • 65 Bertagna F, Barozzi O, Puta E , et al. Residual brain viability, evaluated by (99m)Tc-ECD SPECT, in patients with suspected brain death and with confounding clinical factors. Nucl Med Commun 2009; 30 (10) 815-821
    CrossrefPubMedGoogle Scholar
  • 66 Berenguer CM, Davis FE, Howington JU. Brain death confirmation: comparison of computed tomographic angiography with nuclear medicine perfusion scan. J Trauma 2010; 68 (3) 553-559
    CrossrefPubMedGoogle Scholar
  • 67 Facco E, Zucchetta P, Munari M , et al. 99mTc-HMPAO SPECT in the diagnosis of brain death. Intensive Care Med 1998; 24 (9) 911-917
    CrossrefPubMedGoogle Scholar
  • 68 Kramer AH, Roberts DJ. Computed tomography angiography in the diagnosis of brain death: a systematic review and meta-analysis. Neurocrit Care 2014; 21 (3) 539-550
    CrossrefPubMedGoogle Scholar
  • 69 Taylor T, Dineen RA, Gardiner DC, Buss CH, Howatson A, Pace NL. Computed tomography (CT) angiography for confirmation of the clinical diagnosis of brain death. Cochrane Database Syst Rev 2014; 3: CD009694
    PubMedGoogle Scholar
  • 70 Frisardi F, Stefanini M, Natoli S , et al. Decompressive craniectomy may cause diagnostic challenges to asses brain death by computed tomography angiography. Minerva Anestesiol 2014; 80 (1) 113-118
    PubMedGoogle Scholar
  • 71 Johnston R, Kaliaperumal C, Wyse G, Kaar G. Brain dead or not? CT angiogram yielding false-negative result on brain death confirmation. BMJ Case Rep 2013; ; doi: 10.1136/bcr-2012-007754
    PubMedGoogle Scholar
  • 72 Greer DM, Strozyk D, Schwamm LH. False positive CT angiography in brain death. Neurocrit Care 2009; 11 (2) 272-275
    CrossrefPubMedGoogle Scholar
  • 73 Dupas B, Gayet-Delacroix M, Villers D , et al. Diagnosis of brain death using two-phase spiral CT. AJNR Am J Neuroradiol 2009; 30: 1566-1570
    CrossrefPubMedGoogle Scholar
  • 74 Combes JC, Chomel A, Ricolfi F, d'Athis P, Freysz M. Reliability of computed tomographic angiography in the diagnosis of brain death. Transplant Proc 2007; 39 (1) 16-20
    CrossrefPubMedGoogle Scholar
  • 75 Bohatyrewicz R, Sawicki M, Walecka A , et al. Computed tomographic angiography and perfusion in the diagnosis of brain death. Transplant Proc 2010; 42 (10) 3941-3946
    CrossrefPubMedGoogle Scholar
  • 76 Sawicki M, Bohatyrewicz R, Safranow K , et al. Computed tomographic angiography criteria in the diagnosis of brain death-comparison of sensitivity and interobserver reliability of different evaluation scales. Neuroradiology 2014; 56 (8) 609-620
    CrossrefPubMedGoogle Scholar
  • 77 Yoneda S, Nishimoto A, Nukada T, Kuriyama Y, Katsurada K. To-and-fro movement and external escape of carotid arterial blood in brain death cases. A Doppler ultrasonic study. Stroke 1974; 5 (6) 707-713
    CrossrefPubMedGoogle Scholar
  • 78 Ropper AH, Kehne SM, Wechsler L. Transcranial Doppler in brain death. Neurology 1987; 37 (11) 1733-1735
    CrossrefPubMedGoogle Scholar
  • 79 Conti A, Iacopino DG, Spada A , et al. Transcranial Doppler ultrasonography in the assessment of cerebral circulation arrest: improving sensitivity by transcervical and transorbital carotid insonation and serial examinations. Neurocrit Care 2009; 10 (3) 326-335
    CrossrefPubMedGoogle Scholar
  • 80 Monteiro LM, Bollen CW, van Huffelen AC, Ackerstaff RGA, Jansen NJG, van Vught AJ. Transcranial Doppler ultrasonography to confirm brain death: a meta-analysis. Intensive Care Med 2006; 32 (12) 1937-1944
    CrossrefPubMedGoogle Scholar
  • 81 Dominguez-Roldan JM, Jimenez-Gonzalez PI, Garcia-Alfaro C, Rivera-Fernandez V, Hernandez-Hazañas F. Diagnosis of brain death by transcranial Doppler sonography: solutions for cases of difficult sonic windows. Transplant Proc 2004; 36 (10) 2896-2897
    CrossrefPubMedGoogle Scholar
  • 82 Fages E, Tembl JI, Fortea G , et al. [Clinical usefulness of transcranial Doppler in diagnosis of brain death]. Med Clin (Barc) 2004; 122 (11) 407-412
    CrossrefPubMedGoogle Scholar
  • 83 Dosemeci L, Dora B, Yilmaz M, Cengiz M, Balkan S, Ramazanoglu A. Utility of transcranial Doppler ultrasonography for confirmatory diagnosis of brain death: two sides of the coin. Transplantation 2004; 77 (1) 71-75
    CrossrefPubMedGoogle Scholar
  • 84 Su YY, Zhao H, Zhang Y, Wang X, Hua Y. Studies on evaluation of brain death. Chin J Integr Med 2004; 43: 250-253
    PubMedGoogle Scholar
  • 85 Kuo JR, Chen CF, Chio CC , et al. Time dependent validity in the diagnosis of brain death using transcranial Doppler sonography. J Neurol Neurosurg Psychiatry 2006; 77 (5) 646-649
    CrossrefPubMedGoogle Scholar
  • 86 de Freitas GR, André C. Sensitivity of transcranial Doppler for confirming brain death: a prospective study of 270 cases. Acta Neurol Scand 2006; 113 (6) 426-432
    CrossrefPubMedGoogle Scholar
  • 87 Poularas J, Karakitsos D, Kouraklis G , et al. Comparison between transcranial color Doppler ultrasonography and angiography in the confirmation of brain death. Transplant Proc 2006; 38 (5) 1213-1217
    CrossrefPubMedGoogle Scholar
  • 88 Orban JC, El-Mahjoub A, Rami L, Jambou P, Ichai C. Transcranial Doppler shortens the time between clinical brain death and angiographic confirmation: a randomized trial. Transplantation 2012; 94 (6) 585-588
    PubMedGoogle Scholar
  • 89 Sharma D, Souter MJ, Moore AE, Lam AM. Clinical experience with transcranial Doppler ultrasonography as a confirmatory test for brain death: a retrospective analysis. Neurocrit Care 2011; 14 (3) 370-376
    CrossrefPubMedGoogle Scholar
  • 90 Brunser A, Hoppe A, Cárcamo DA , et al. [Validation of transcranial Doppler in the diagnosis of brain death]. Rev Med Chil 2010; 138 (4) 406-412
    PubMedGoogle Scholar
  • 91 Escudero D, Otero J, Marqués L , et al. Diagnosing brain death by CT perfusion and multislice CT angiography. Neurocrit Care 2009; 11 (2) 261-271
    CrossrefPubMedGoogle Scholar
  • 92 Cacciatori A, Castro A, Godino M, Mizraji R, Alvarez I. Transcranial Doppler in the diagnosis of cerebral circulatory arrest: cases of the National Institute of Donation and Transplantation of Uruguay. Transplant Proc 2014; 46 (9) 2947-2949
    CrossrefPubMedGoogle Scholar
  • 93 Kirkham FJ, Levin SD, Padayachee TS, Kyme MC, Neville BG, Gosling RG. Transcranial pulsed Doppler ultrasound findings in brain stem death. J Neurol Neurosurg Psychiatry 1987; 50 (11) 1504-1513
    CrossrefPubMedGoogle Scholar
  • 94 Newell DW, Grady MS, Sirotta P, Winn HR. Evaluation of brain death using transcranial Doppler. Neurosurgery 1989; 24 (4) 509-513
    CrossrefPubMedGoogle Scholar
  • 95 Hassler W, Steinmetz H, Gawlowski J. Transcranial Doppler ultrasonography in raised intracranial pressure and in intracranial circulatory arrest. J Neurosurg 1988; 68 (5) 745-751
    PubMedGoogle Scholar
  • 96 Van Velthoven V, Calliauw L. Diagnosis of brain death. Transcranial Doppler sonography as an additional method. Acta Neurochir (Wien) 1988; 95 (1-2) 57-60
    CrossrefPubMedGoogle Scholar
  • 97 Thompson BB, Wendell LC, Potter NS , et al. The use of transcranial Doppler ultrasound in confirming brain death in the setting of skull defects and extraventricular drains. Neurocrit Care 2014; 21 (3) 534-538
    CrossrefPubMedGoogle Scholar
  • 98 Kumada K, Fukuda A, Yamane K , et al. [Diffusion-weighted imaging of brain death: study of apparent diffusion coefficient]. No To Shinkei 2001; 53 (11) 1027-1031
    PubMedGoogle Scholar
  • 99 Selcuk H, Albayram S, Tureci E , et al. Diffusion-weighted imaging findings in brain death. Neuroradiology 2012; 54 (6) 547-554
    CrossrefPubMedGoogle Scholar
  • 100 Luchtmann M, Bernarding J, Beuing O , et al. Controversies of diffusion weighted imaging in the diagnosis of brain death. J Neuroimaging 2013; 23 (4) 463-468
    CrossrefPubMedGoogle Scholar
  • 101 Aichner F, Felber S, Birbamer G, Luz G, Judmaier W, Schmutzhard E. Magnetic resonance: a noninvasive approach to metabolism, circulation, and morphology in human brain death. Ann Neurol 1992; 32 (4) 507-511
    CrossrefPubMedGoogle Scholar
  • 102 Ishii K, Onuma T, Kinoshita T, Shiina G, Kameyama M, Shimosegawa Y. Brain death: MR and MR angiography. AJNR Am J Neuroradiol 1996; 17 (4) 731-735
    PubMedGoogle Scholar
  • 103 Matsumura A, Meguro K, Tsurushima H , et al. Magnetic resonance imaging of brain death. Neurol Med Chir (Tokyo) 1996; 36 (3) 166-171
    CrossrefPubMedGoogle Scholar
  • 104 Karantanas AH, Hadjigeorgiou GM, Paterakis K, Sfiras D, Komnos A. Contribution of MRI and MR angiography in early diagnosis of brain death. Eur Radiol 2002; 12 (11) 2710-2716
    PubMedGoogle Scholar
  • 105 Sohn CH, Lee HP, Park JB , et al. Imaging findings of brain death on 3-Tesla MRI. Korean J Radiol 2012; 13 (5) 541-549
    CrossrefPubMedGoogle Scholar
  • 106 Minami T, Ogawa M, Sugimoto T, Katsurada K. Hyperoxia of internal jugular venous blood in brain death. J Neurosurg 1973; 39 (4) 442-447
    CrossrefPubMedGoogle Scholar
  • 107 Díaz-Regañón G, Miñambres E, Holanda M, González-Herrera S, López-Espadas F, Garrido-Díaz C. Usefulness of venous oxygen saturation in the jugular bulb for the diagnosis of brain death: report of 118 patients. Intensive Care Med 2002; 28 (12) 1724-1728
    CrossrefPubMedGoogle Scholar
  • 108 Hantson P, Mahieu P. Usefulness of cerebral venous monitoring through jugular bulb catheterization for the diagnosis of brain death. Intensive Care Med 1992; 18 (1) 59
    PubMedGoogle Scholar
  • 109 Kyttä J, Ohman J, Tanskanen P, Randell T. Extracranial contribution to cerebral oximetry in brain dead patients: a report of six cases. J Neurosurg Anesthesiol 1999; 11 (4) 252-254
    CrossrefPubMedGoogle Scholar
  • 110 van Santbrink H, Maas AI, Avezaat CJ. Continuous monitoring of partial pressure of brain tissue oxygen in patients with severe head injury. Neurosurgery 1996; 38 (1) 21-31
    CrossrefPubMedGoogle Scholar
  • 111 Artru F, Jourdan C, Perret-Liaudet A, Charlot M, Mottolese C. Low brain tissue oxygen pressure: incidence and corrective therapies. Neurol Res 1998; 20 (Suppl. 01) S48-S51
    PubMedGoogle Scholar
  • 112 Palmer S, Bader MK. Brain tissue oxygenation in brain death. Neurocrit Care 2005; 2 (1) 17-22
    CrossrefPubMedGoogle Scholar
  • 113 Smith ML, Counelis GJ, Maloney-Wilensky E, Stiefel MF, Donley K, LeRoux PD. Brain tissue oxygen tension in clinical brain death: a case series. Neurol Res 2007; 29 (7) 755-759
    CrossrefPubMedGoogle Scholar
  • 114 Vivien B, Paqueron X, Le Cosquer P, Langeron O, Coriat P, Riou B. Detection of brain death onset using the bispectral index in severely comatose patients. Intensive Care Med 2002; 28 (4) 419-425
    CrossrefPubMedGoogle Scholar
  • 115 Escudero D, Otero J, Muñiz G , et al. The Bispectral Index Scale: its use in the detection of brain death. Transplant Proc 2005; 37 (9) 3661-3663
    CrossrefPubMedGoogle Scholar
  • 116 Okuyaz C, Birbiçer H, Doruk N, Atici A. Bispectral index monitoring in confirmation of brain death in children. J Child Neurol 2006; 21 (9) 799-801
    CrossrefPubMedGoogle Scholar
  • 117 Misis M, Raxach JG, Molto HP, Vega SM, Rico PS. Bispectral index monitoring for early detection of brain death. Transplant Proc 2008; 40 (5) 1279-1281
    CrossrefPubMedGoogle Scholar
  • 118 Myles PS, Cairo S. Artifact in the bispectral index in a patient with severe ischemic brain injury. Anesth Analg 2004; 98 (3) 706-707
    PubMedGoogle Scholar
  • 119 Wennervirta J, Salmi T, Hynynen M , et al. Entropy is more resistant to artifacts than bispectral index in brain-dead organ donors. Intensive Care Med 2007; 33 (1) 133-136
    CrossrefPubMedGoogle Scholar
  • 120 Fyntanidou B, Grosomanidis V, Aidoni Z , et al. Bispectral Index Scale variations in patients diagnosed with brain death. Transplant Proc 2012; 44 (9) 2702-2705
    CrossrefPubMedGoogle Scholar
  • 121 Facco E, Munari M, Gallo F , et al. Role of short latency evoked potentials in the diagnosis of brain death. Clin Neurophysiol 2002; 113 (11) 1855-1866
    CrossrefPubMedGoogle Scholar
  • 122 Ruiz-López MJ, Martínez de Azagra A, Serrano A, Casado-Flores J. Brain death and evoked potentials in pediatric patients. Crit Care Med 1999; 27 (2) 412-416
    CrossrefPubMedGoogle Scholar
  • 123 Roncucci P, Lepori P, Mok MS, Bayat A, Logi F, Marino A. Nasopharyngeal electrode recording of somatosensory evoked potentials as an indicator in brain death. Anaesth Intensive Care 1999; 27 (1) 20-25
    PubMedGoogle Scholar
  • 124 Kojder I, Garell S, Włodarczyk E, Sagan L, Jezewski D, Slósarek J. [Brain stem auditory evoked potentials in brain death state]. Neurol Neurochir Pol 1998; 32 (1) 103-109
    PubMedGoogle Scholar
  • 125 Wagner W. Scalp, earlobe and nasopharyngeal recordings of the median nerve somatosensory evoked P14 potential in coma and brain death. Detailed latency and amplitude analysis in 181 patients. Brain 1996; 119 (Pt 5) 1507-1521
    CrossrefPubMedGoogle Scholar
  • 126 Sandroni C, Cariou A, Cavallaro F , et al. Prognostication in comatose survivors of cardiac arrest: an advisory statement from the European Resuscitation Council and the European Society of Intensive Care Medicine. Intensive Care Med 2014; 40 (12) 1816-1831
    CrossrefPubMedGoogle Scholar