Unexpected death during a brain scintigraphy

Brain scintigraphy was performed for differential diagnosis of suspected subdural hemorrhage in a 79-year-old woman. Planar pertechnetate (99mTcO4-) brain scan with AP, PA, lateral and vertex projections was planned. The procedure was started with AP-projection, continuing with lateral projections. After these images the patient was determined dead and the planned scannings were aborted. There was a clear difference in the intracranial uptake (choroid plexuses) in the lateral views as well as in the uptake in the venous sinuses. The findings in the AP view were normal and no signs of subdural hemorrhage were observed. The patient died during a routine nuclear medicine procedure, and cessation of intracranial circulation was observable on 99mTcO4- scans; the lack of uptake in cerebral sinuses confirmed the lack of intracerebral flow. In this rare case, brain death could be timed accurately using a static nuclear medicine procedure. Autopsy confirmed sudden brain circulatory disorders and general arteriosclerosis.