Diagnosing brain death using the transcranial Doppler with a transorbital approach.
BACKGROUND
Transcranial Doppler is a sensitive instrument for the diagnosis of brain death. The guidelines for the determination of brain death include the demonstration of specific blood flow patterns in the anterior and posterior circulation systems. A limitation of this method is the frequent false finding of no flow, especially when using the transtemporal approach in older women.


OBJECTIVE
To evaluate the efficacy of the transorbital approach in the diagnosis of brain death using transcranial Doppler.


METHODS
A prospective controlled, diagnostic test study was performed. Transorbital, transtemporal, and transforaminal approaches were used. Fifty-seven patients (29 men and 28 women; mean +/- SD age, 68.2 +/- 12.1 years) with clinically determined brain death were examined.


RESULTS
In 45 patients, oscillatory flow or systolic spikes were found in all approaches. In 4 patients, no flow was detected. In 6 patients, oscillatory flow or systolic spikes were found in 2 approaches, including the transorbital one. In 2 patients, a positive finding was demonstrated only using the transorbital approach. Using the transorbital approach, the percentage of positive findings with definitive diagnoses of brain death rose from 79% to 88%.


CONCLUSIONS
The transorbital approach is a useful addition for the diagnosis of brain death, using the transcranial Doppler technique.
Lampl
Yair
Y
Department of Neurology, The E. Wolfson Medical Center, Holon 58100, Israel.
Gilad
Ronit
R
Eschel
Yehiel
Y
Boaz
Mona
M
Rapoport
Abraham
A
Sadeh
Menachem
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001926:Brain Death / Q000175:diagnosis*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D009915:Orbit; D011446:Prospective Studies; D015203:Reproducibility of Results; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data