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False-negative cerebral radionuclide flow study, in brain death, caused by a ventricular drain
A V Hansen1, P J Lavin, E B Moody
1Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2675.
Clinical Nuclear Medicine
|June 1, 1993
Summary
A ventricular drain can falsely indicate normal cerebral blood flow in brain death cases. Removing the obstructed drain revealed no flow, confirming the drain
Area of Science:
- Neurology
- Radiology
- Critical Care Medicine
Background:
- Brain death diagnosis relies on demonstrating cessation of cerebral blood flow.
- Radionuclide cerebral blood flow studies are a common diagnostic tool.
- Intracranial pressure monitoring devices, like ventricular drains, can potentially affect cerebral perfusion.
Observation:
- A patient with clinical and electrical brain death showed normal cerebral blood flow on initial radionuclide study.
- The patient had an indwelling ventricular drain at the time of the initial study.
- The ventricular drain subsequently became obstructed.
Findings:
- Removal of the obstructed ventricular drain was followed by a repeat radionuclide cerebral blood flow study.
- The repeat study demonstrated absent cerebral blood flow, consistent with brain death.
- The initial false-negative result was attributed to the presence of the ventricular drain.
Implications:
- Ventricular drains may create a false-negative in radionuclide cerebral blood flow studies for brain death.
- Clinicians must consider the potential impact of intracranial devices on cerebral blood flow assessments.
- This case highlights the importance of careful interpretation of diagnostic tests in the context of interventions.