Evaluation of brain death by contrast-enhanced computerized cranial tomography

Area of Science:

• Neurology
• Radiology
• Forensic Medicine

Background:

• Establishing cerebral death requires definitive evidence of absent brain function and irreversible cessation of circulation.
• Traditional methods include clinical examination, electroencephalography (EEG), and cerebral angiography.

Observation:

• Four patients meeting clinical criteria for cerebral death underwent contrast-enhanced computerized cranial tomography (CT).
• Intravenous injection of meglumine diatrizoate resulted in a failure of intracranial vascular structures to enhance on CT scans.
• Two patients also had EEG, and one had cerebral angiography, corroborating the CT findings of no cerebral blood flow.

Findings:

• Contrast-enhanced CT demonstrated a lack of vascular enhancement in the intracranial arteries and veins.
• This absence of enhancement correlated with the confirmed lack of cerebral blood flow in all evaluated patients.
• The findings suggest CT angiography can visualize the cessation of intracranial circulation.

Implications:

• Contrast-enhanced CT offers a potentially valuable, non-invasive adjunct in the diagnostic process for cerebral death.
• This imaging modality may help confirm the absence of cerebral perfusion and elucidate the underlying cause of brain death.
• CT may reduce the need for more invasive procedures like cerebral angiography in specific cases.