"Hot nose" sign in brain death

Area of Science:

• Neurology
• Nuclear Medicine

Background:

• Brain death diagnosis necessitates rigorous clinical examination.
• Ancillary testing may be required in specific clinical scenarios.

Observation:

• A 30-year-old male with severe head trauma presented with absent brainstem responses.
• A nuclear medicine brain scan was performed as part of the diagnostic workup.

Findings:

• The scan demonstrated carotid arterial flow to the skull base but no intracranial arterial flow.
• A characteristic "hot nose" sign was observed, consistent with brain death.

Implications:

• The "hot nose" sign, linked to external carotid artery flow, can be an indicator of brain death.
• This case highlights the utility of nuclear medicine imaging in confirming brain death when clinical examination is equivocal.