[Clinical usefulness of transcranial Doppler in diagnosis of brain death].
OBJECTIVE
The use of transcranial doppler (TD) for the assessment of critical neurological patients and brain death (BD) is steadily growing. In this study we describe the daily clinical practice around BD diagnosis and compare the usefulness of TD, including advantages and shortcomings, with that of other tests.


METHODS
A series of 100 patients diagnosed of brain death is presented including the demographic and clinical data as well as the results of ancillary tests (CE).


RESULTS
Fifty eight patients were males with a mean age of 46. The most frequent etiology of coma was spontaneous cerebral hemorrhage. Central nervous system depressants had been administered to 62 patients within a few hours prior to the diagnosis. When ancillary tests were performed, only 55% patients fulfilled the currently accepted clinical criteria for brain death. TD was performed in 44 patients and 80% of them showed a pattern supporting a brain death diagnosis. Definitive diagnostic tests were electroencephalogram (EEG) in 53% patients and TD in 35% of them. In ten cases, discrepancies were observed between the results offered by these tests.


CONCLUSIONS
Transcraneal Doppler stands out as a safe, fast, inexpensive and bloodless method of assessment of the critical neurological patient and for BD diagnosis. It is the choice test in the presence of central nervous system depressant drugs, abuse of substances or coma of unknown etiology. The main limitations of this technique are the presence of extensive craniotomies and the absence of an adequate acoustic window.
Fages
Eva
E
Servicio de Neurología. Hospital Universitario La Fe. Valencia. Spain. evafa@ole.com
Tembl
José Ignacio
JI
Fortea
Gerardo
G
López
Pablo
P
Lago
Aida
A
Vicente
José Luis
JL
Vilchez
Juan Jesús
JJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D001926:Brain Death / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017585:Ultrasonography, Doppler, Transcranial