Transcranial Doppler in brain death confirmation in clinical practice.
OBJECTIVE
Transcranial Doppler (TCD) can be used as a confirmatory test in brain death. The aim was to present the usefulness of TCD in brain death confirmation.


METHODS
Forty-four patients with severe brain lesions leading to brain death were treated over a 4-year period. After the clinical diagnosis of brain death was made, the appropriate confirmatory test was chosen according to patient condition, taking into consideration the restrictions of the test protocol. Due to the inconclusive test results, some patients underwent repeat testing.


RESULTS
Among 44 patients, 19 had neurotrauma, 11 massive aneurysmal subarachnoidal hemorrhages, 1 arteriovenous subarachnoidal and parenchymal hemorrhage, 12 hypertensive parenchymal hemorrhages, and 1 ischemic stroke. As a primary test, TCD was used in 30, brain scintigraphy in 2, multislice CT angiography (CTA) in 10, and cerebral angiography in 2 patients, and the diagnosis was confirmed in 26, 3, 9 and 2 patients, respectively. Due to inconclusive results CTA was repeated in five patients. In patients in whom TCD was applied, the time to confirm the diagnosis was the shortest, and in most (61 %) cerebral circulatory arrest was confirmed within 2 hours of clinical diagnosis.


CONCLUSIONS
TCD is a favorable confirmatory test for cerebral circulatory arrest in brain death diagnosis.
Lovrencic-Huzjan
A
A
University Department of Neurology, University Hospital Sestre milosrdnice, Zagreb. arijana.lovrencic-huzjan@zg.htnet.hr
Vukovic
V
V
Gopcevic
A
A
Vucic
M
M
Kriksic
V
V
Demarin
V
V
D000293:Adolescent; D000328:Adult; D000368:Aged; D001926:Brain Death / Q000000981:diagnostic imaging*; D001930:Brain Injuries / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000000981:diagnostic imaging; D005260:Female; D005583:Fourier Analysis; D006801:Humans; D020299:Intracranial Hemorrhage, Hypertensive / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging; D009927:Tissue and Organ Procurement; D036542:Tomography, Spiral Computed; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*; D055815:Young Adult