title: Brain dead or not? CT angiogram yielding false-negative result on brain death confirmation.
abstract: We describe a case of severe traumatic brain injury with multiple facial and skull fractures where CT angiogram (CTA) failed to yield a definite result of brain death as an ancillary test. A 28-year-old man was admitted following a road traffic accident with a Glasgow Coma Score (GCS) of 3/15 and fixed pupils. CT brain revealed uncal herniation and diffuse cerebral oedema with associated multiple facial and skull fractures. 72 h later, his clinical condition remained the same with high intracranial pressure refractory to medical management. Clinical confirmation on brain death was not feasible owing to facial injuries. A CTA, performed to determine brain perfusion, yielded a 'false-negative' result. Skull fractures have possibly led to venous prominence in the cortical and deep venous drainage system. This point needs to be borne in mind while considering CTA as an ancillary test to confirm brain death.
authors.affiliation: Department of Neurosurgery,  Cork University Hospital, Cork,  Ireland.
authors.forename: Robyn
authors.initials: R
authors.lastname: Johnston
authors.forename: Chandrasekaran
authors.initials: C
authors.lastname: Kaliaperumal
authors.forename: Gerald
authors.initials: G
authors.lastname: Wyse
authors.forename: George
authors.initials: G
authors.lastname: Kaar
mesh_terms: D000328:Adult; D001926:Brain Death / Q000175:diagnosis*; D001930:Brain Injuries / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography; D005188:False Negative Reactions; D006801:Humans; D008297:Male; D012887:Skull Fractures / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed