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Identification by CT scan of ischemic stroke patients with high risk of brain death
J M Dominguez-Roldan1, P I Jimenez-Gonzalez, C Garcia-Alfaro
1Hospital Universitario Virgen del Rocio, Sevilla, Spain.
Insights
Identifying patients at high risk of brain death is crucial. CT scan findings like midline shifts in ischemic stroke patients admitted to the ICU can predict this progression.
Area of Science:
- Neurology
- Radiology
- Critical Care Medicine
Background:
- Identifying potential organ donors is vital for transplant coordination teams.
- While head injuries and hemorrhagic strokes are common causes of brain death, ischemic strokes also contribute.
- Early identification of patients progressing to brain death is essential.
Purpose of the Study:
- To identify radiological signs on admission CT scans associated with progression to brain death in ischemic stroke patients.
- To evaluate the predictive value of specific CT findings for brain death evolution.
Main Methods:
- Retrospective analysis of CT scans from 15 brain-dead patients with ischemic stroke.
- Comparison with CT scans from 15 recovered ischemic stroke patients admitted to the ICU.
- Assessment of radiological signs including insular ribbon sign, arterial hyperintensities, hypodensities, midline shift, and cerebrospinal fluid space compression.
Main Results:
- Midline shifts were significantly associated with brain death.
- Compression of the ambiens cistern was also significantly linked to brain death.
- Other studied radiological signs did not show significant association.
Conclusions:
- CT scan analysis at ICU admission can predict the risk of brain death in ischemic stroke patients.
- Midline shifts and ambiens cistern compression are key indicators of brain death progression.
- This finding aids in early identification and management of high-risk patients.
Abstract:
The identification of patients with high risk of evolution to brain death is one of the more important tasks of transplant coordination teams. Although most of pool of potential donors come from the group of patients who suffer a head injury or hemorrhagic stroke, the procurement of organs from brain-dead patients suffering an ischemic stroke as the cause of brain damage must also be considered. The main objective of this study was to investigate the radiological signs that in the CT scan of admission to a neurological ICU are more frequently associated with progression to brain death. We studied the CT scans of 15 brain-dead patients after an ischemic stroke versus the scans of 15 recovered patients admitted to ICU with the same diagnosis. The radiological signs included: insular ribbon sign, hyperintensities inside the big arteries of the base of the skull, hemispheric hypodensities, midline shift, and compression of the cerebrospinal fluid spaces. There were two signs significantly associated with brain death: midline shifts and the compression of the ambiens cistern. It may be concluded that analysis of the CT scan at admission of patients with an ischemic stroke in the ICU can predict the risk of evolution to brain death.
