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Reversal of diastolic cerebral blood flow in infants without brain death
1Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan, Republic of China.
Insights
Diastolic flow reversal in cerebral blood flow, typically a sign of brain death, can be reversed with prompt medical or surgical intervention. These cases show survival is possible even with this critical indicator.
Area of Science:
- Neurology
- Neurocritical Care
- Diagnostic Ultrasound
Background:
- Diastolic flow reversal in cerebral blood flow (CBF) is a recognized indicator of brain death.
- This waveform is typically associated with irreversible neurological damage.
Observation:
- Two pediatric patients presented with diastolic flow reversal.
- One infant experienced reversal due to status epilepticus and intracranial pressure.
- Another infant showed reversal during acute deterioration from a choroid plexus papilloma.
Findings:
- Both patients survived following targeted medical or surgical interventions.
- The infant with status epilepticus recovered fully after seizure control and management of intracranial pressure.
- The infant with a tumor survived after emergent surgical resection, albeit with residual deficits.
Implications:
- Diastolic flow reversal does not always signify irreversible brain death.
- Prompt and effective treatment can alter the outcome in critical neurological conditions.
- This highlights the importance of considering treatable causes even with severe hemodynamic changes.
Abstract:
The reversal of diastolic cerebral blood flow has been regarded as a characteristic waveform of brain death and a useful confirming sign. We report 2 patients who had diastolic flow reversal but survived. One, a 1-month-old boy with status epilepticus, had reversal of diastolic cerebral blood flow detected by Doppler ultrasound soon after admission. Reversal disappeared after medical management for increased intracranial pressure and seizure control. He recovered without sequelae. The other, a 6-month-old girl with choroid plexus papilloma, had reversal of diastolic flow during abrupt clinical deterioration. Emergent surgical removal of the tumor was performed and she survived with hemiparesis and psychomotor retardation. Our patients demonstrated that even in the presence of diastolic reversal of cerebral blood flow, prompt and effective treatment can avoid a fatal outcome.