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MR 'hot nose sign' and 'intravascular enhancement sign' in brain death

W W Orrison1, A M Champlin, O L Kesterson

  • 1Department of Radiology, University of New Mexico School of Medicine, Albuquerque 87131-5336.

Insights

Magnetic Resonance Imaging (MRI) can aid in diagnosing brain death. Specific signs like "hot nose" and "intravascular enhancement" on MRI, alongside herniation and absent flow voids, support the clinical diagnosis.

Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Diagnosing cerebral death requires definitive criteria.
  • Magnetic Resonance Imaging (MRI) is a valuable tool in neurological assessment.

Observation:

  • Three cases of brain death evaluated using MRI with gadopentetate dimeglumine are presented.
  • Distinctive imaging signs were observed, including the "hot nose sign" and "intravascular enhancement sign".

Findings:

  • MRI findings in brain death include transtentorial/foramen magnum herniation.
  • Absence of intracranial vascular flow void and poor gray/white matter differentiation were noted.
  • Key signs included absent intracranial contrast enhancement, carotid artery enhancement ("intravascular enhancement sign"), and prominent nasal/scalp enhancement ("MR hot nose sign").

Implications:

  • These MRI findings offer supplementary evidence for the clinical diagnosis of brain death.
  • The "hot nose sign" and "intravascular enhancement sign" may improve diagnostic accuracy.
  • Understanding these advanced MRI findings is crucial for confirming cessation of brain function.

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