Usefulness of Intracranial CT Angiography with Spiral CT in Brain Death - A Preliminary Report ?

J Korean Neurol Assoc > Volume 17(4); 1999 > Article

Journal of the Korean Neurological Association 1999;17(4): 554-560.

뇌사 판정에 있어서 두개내 나선식 CT 혈관조영술의 유용성 -예비보고 -

박종호, 송홍기 ·윤대영*

한림대학교 의과대학 신경과학교실,진단방사선과학교실*

Usefulness of Intracranial CT Angiography with Spiral CT in Brain Death - A Preliminary Report ?

Jong-Ho Park, M.D., Hong-Ki Song, M.D., Dae-Young Yoon, M.D.

Department of Neurology and Radiology*, Hallym University College of Medicine

Abstract

Background : The increasing implementation of organ transplantation requires an unequivocal diagnosis of brain death for moral and legal reasons. Among instrumental investigations, angiographic demonstration of absent intracranial blood flow is considered to be the most reliable test in diagnosing brain death. This test should be easily accessible since most brain dead patients are vitally unstable and have various life-supporting equipments besides their beds. To investigate the usefulness of an intracranial CT angiography (CTA) for the diagnosis of brain death, we performed CTA in comatose patients who were either clinically brain dead or not. Methods : Fourteen comatose patients (11 male and 3 female, aged from 17 to 63 years) with various brain insults were included in this study. Eleven patients were clinically brain dead. Among the remaining three patients, one showed subtle withdrawal movements in one extremity to noxious stimuli with absent brainstem reflexes, and the other two showed multifocal myoclonic seizures. CT scanning was performed with a table speed of 2 mm/sec, twenty seconds after beginning an injection of contrast media. The data were reformatted by maximum intensity projection (MIP) and shaded surface display (SSD) after the reconstruction of a 1 mm interval. A portable electroencephalography (EEG) was also taken serially in clinically brain dead patients except one. Results : Intracranial arterial blood flow was preserved in those who showed either a seizure, abnormal posture or intact brainstem reflexes. On the other hand, intracranial arteries were not visualized in all brain dead patients with electrocerebral silence (ECS) on their EEG with the exception of one patient whose EEG was difficult to determine a ECS due to excessive mechanical artifacts. However, in the clinically brain dead patients, the intracranial arterial flow was preserved in those who suffered from widespread brainstem and cerebellar infarction or whose EEG demonstrated periodic lateralizing epileptiform discharges or a burst suppression pattern. Conclusions : Intracranial CTA seems to be a safe and noninvasive procedure for the determination of brain death that produces fast, reliable, and easy-to-interpret results. It can be used as an alternative method to the EEG when the EEG is not possible or difficult to interpret due to artifacts. J Kor Neurol Ass 17(4):554~560, 1999 Key Words : Brain Death, Intracranial CT Angiography

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