The role of transcranial Doppler in confirming brain death: sensitivity, specificity, and suggestions for performance and interpretation.
We performed transcranial Doppler (TCD) examinations on 54 comatose patients over a 1-year period. Of 49 patients with technically adequate TCD examinations, 23 met criteria for determination of brain death by clinical and EEG criteria (21) or clinical criteria alone (2; EEG not performed). A TCD waveform abnormality, consisting of absent or reversed diastolic flow, or small early systolic spikes, in at least 2 intracranial arteries, occurred in 21 brain-dead patients, but in none of the other patients in coma. With appropriate guidelines for performance and interpretation, TCD could be incorporated into institutional protocols as a rapid and convenient alternative to EEG for confirmation of brain death.
Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY.
G W
GW
Petty
J P
JP
Mohr
T A
TA
Pedley
T K
TK
Tatemichi
L
L
Lennihan
D I
DI
Duterte
R L
RL
Sacco
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001926:Brain Death / Q000175:diagnosis*; D002985:Clinical Protocols; D003128:Coma / Q000209:etiology / Q000503:physiopathology; D004569:Electroencephalography; D006801:Humans; D008875:Middle Aged; D012680:Sensitivity and Specificity; D014463:Ultrasonography