title: Technical aids in the diagnosis of brain death: a comparison of SEP, AEP, EEG, TCD and CT angiography.
abstract: BACKGROUND
  The use of technical aids to confirm brain death is a controversial matter. Angiography with the intra-arterial administration of contrast medium is the international gold standard, but it is not allowed in Germany except in cases where it provides a potential mode of treatment. The currently approved tests in Germany are recordings of somatosensory evoked potentials (SSEP), brain perfusion scintigraphy, transcranial Doppler ultrasonography (TCD), and electroencephalography (EEG). CT angiography (CTA), a promising new alternative, is being increasingly used as well.
  
  
  METHODS
  In a prospective, single-center study that was carried out from 2008 to 2011, 71 consecutive patients in whom brain death was diagnosed on clinical grounds underwent recording of auditory evoked potentials (AEP) and SSEP as well as EEG, TCD and CTA.
  
  
  RESULTS
  The validity of CTA for the confirmation of brain death was 94%; the validity of the other tests was: 94% for EEG, 92% for TCD, 82% for SSEP, and 2% for AEP. In 61 of the 71 patients (86%), the EEG, TCD and CTA findings all accorded with the clinical diagnosis. The diagnosis of brain death was established beyond doubt in all patients.
  
  
  CONCLUSIONS
  In this study, the technical aids yielded discordant results in 14% of cases, necessitating interpretation by an expert examiner. The perfusion tests, in particular, can give false-positive results in patients with large cranial defects, skull fractures, or cerebrospinal fluid drainage. In such cases, electrophysiologic tests or a repeated clinical examination should be performed instead. CTA is a promising, highly reliable new method for demonstrating absent intracranial blood flow. In our view, it should be incorporated into the German guidelines for the diagnosis of brain death.
authors.affiliation: Department of Neurotraumatology and Neurosurgery, Asklepios Hospital Weißenfels, Trauma Center.
authors.forename: Stefan
authors.initials: S
authors.lastname: Welschehold
authors.forename: Stephan
authors.initials: S
authors.lastname: Boor
authors.forename: Katharina
authors.initials: K
authors.lastname: Reuland
authors.forename: Frank
authors.initials: F
authors.lastname: Thömke
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerz
authors.forename: André
authors.initials: A
authors.lastname: Reuland
authors.forename: Christian
authors.initials: C
authors.lastname: Beyer
authors.forename: Martin
authors.initials: M
authors.lastname: Gartenschläger
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Wagner
authors.forename: Alf
authors.initials: A
authors.lastname: Giese
authors.forename: Wibke
authors.initials: W
authors.lastname: Müller-Forell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001926:Brain Death / Q000175:diagnosis* / Q000503:physiopathology; D001933:Brain Stem / Q000503:physiopathology; D002533:Cerebral Angiography; D004569:Electroencephalography; D005072:Evoked Potentials, Auditory / Q000502:physiology*; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D017585:Ultrasonography, Doppler, Transcranial; D055815:Young Adult