Plain CT findings of brain death confirmed by hollow skull sign in brain perfusion SPECT

Computed tomographic (CT) findings of 13 patients manifesting brain death were reviewed. This diagnosis was confirmed by the so-called "hollow skull" pattern observed in brain perfusion single photon emission computed tomography (SPECT), which was performed between 4 hours before and 3 days after the CT scans, and by subsequent corporal death. The brain perfusion SPECT was performed with the intravenous administration of technetium (Tc)-99m-hexamethylpropyleneamine oxime (HMPAO) or iodine (I)-123-N-isopropyl-p-iodoamphetamine (IMP). CT scans showed diffuse cerebral edema and the loss of gray-white matter differentiation in all the cases, and transtentorial herniation in 12 patients. These CT findings were considered predictive of brain death.