Brain dead or not? CT angiogram yielding false-negative result on brain death confirmation

Area of Science:

• Neurology
• Radiology
• Trauma Surgery

Background:

• Severe traumatic brain injury (TBI) necessitates accurate diagnosis of brain death.
• CT angiogram (CTA) is an ancillary test used to assess cerebral perfusion for brain death confirmation.
• Facial and skull fractures can complicate clinical examination and diagnostic imaging in TBI.

Observation:

• A 28-year-old male with severe TBI, Glasgow Coma Score (GCS) of 3, and fixed pupils presented with diffuse cerebral edema and multiple facial/skull fractures.
• Despite refractory high intracranial pressure, clinical brain death determination was challenging due to facial injuries.
• A CTA performed to assess brain perfusion yielded a false-negative result for brain death.

Findings:

• The false-negative CTA result in this severe TBI case may be attributed to venous prominence in the cortical and deep venous drainage system, potentially caused by skull fractures.
• This finding highlights a limitation of CTA in specific complex TBI scenarios.

Implications:

• CTA should be interpreted with caution as an ancillary test for brain death confirmation in patients with severe TBI and complex facial/skull fractures.
• Consideration of fracture-induced venous alterations is crucial for accurate CTA assessment in TBI.
• Further research may be needed to refine CTA protocols or explore alternative imaging modalities for brain death confirmation in such complex cases.