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Brain death due to supratentorial masses: diagnosis using transcranial Doppler sonography
J-M Dominguez-Roldan1, C Garcia-Alfaro, P-I Jimenez-Gonzalez
1Roldan Hospital Virgen del Rocio, Sevilla, Spain. jmdominguez@telefonica.net
Insights
Transcranial Doppler sonography demonstrates high sensitivity for diagnosing brain death by detecting cerebral circulatory arrest. Specific Doppler patterns vary based on the location of intracranial mass effects.
Area of Science:
- Neurology
- Medical Imaging
- Critical Care Medicine
Background:
- Cadaveric organ donation relies heavily on accurate brain death diagnosis.
- Cessation of cerebral circulation is a key indicator of brain death.
- Transcranial Doppler (TCD) sonography is used to assess cerebral circulation but has questioned sensitivity.
Purpose of the Study:
- To evaluate the sensitivity of TCD sonography for diagnosing brain death.
- To determine if intracranial mass effect location influences TCD findings.
Main Methods:
- Twenty-four patients underwent TCD sonography to identify patterns associated with brain death.
- Sonographic patterns analyzed included diastole-systole separation, reverberating flow, and systolic spikes.
- Insonation focused on arteries at the base of the skull.
Main Results:
- TCD sonography exhibited high sensitivity in diagnosing brain death.
- Reverberating flow was the predominant pattern in supratentorial lesions.
- Systolic spikes were most frequent in infratentorial lesions, indicating varied circulatory arrest mechanisms.
Conclusions:
- TCD sonography is a sensitive tool for diagnosing brain death.
- The location of intracranial mass effects influences the specific sonographic patterns observed.
- Understanding these patterns aids in diagnosing cerebral circulatory arrest.
Abstract:
Since cadaveric donation is the main source of organs for transplantation in many countries, the diagnosis of brain death is an important issue. The cessation of cerebral circulation is one phenomenon closely related to brain death. Transcranial Doppler sonography is one of the accepted techniques to establish cessation of cerebral circulation. One of the limitations attributed to Doppler is the lack of sensitivity for this diagnosis. The objective of this research was to establish whether transcranial Doppler sonography showed acceptable sensitivity and whether this was affected by the location of the intracranial mass effect. Twenty-four patients underwent transcranial Doppler sonography to establish the incidence of the three sonographic patterns associated with brain death: separation diastole-systole, reverberating flow, and systolic spikes. In all the cases the insonation of the arteries of the base of the skull was performed. In supratentorial lesions, the predominant pattern was a reverberating flow, while in infratentorial lesions systolic spikes pattern was most frequent. Our study showed a high sensitivity of transcranial Doppler sonography for the diagnosis of brain death and the existence of different mechanisms of cerebral circulatory arrest depending on the location of the intracranial pressure wedge.
