The use of transcranial Doppler ultrasound in confirming brain death in the setting of skull defects and extraventricular drains.
BACKGROUND
Transcranial Doppler ultrasound (TCD) has been used as a confirmatory test for the diagnosis of brain death (BD), but may be inaccurate in patients with a skull defect or extraventricular drain (EVD).


RESULTS
We report three cases of patients with a skull defect or EVD in whom TCD supported a diagnosis of BD but in which the clinical examination later refuted the diagnosis.


CONCLUSIONS
We caution against the use of TCD to confirm the diagnosis of BD in the presence of a skull defect or EVD.
Department of Neurology, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, 593 Eddy Street, APC-712, Providence, RI, 02903, USA, bthompson@lifespan.org.
Bradford B
BB
Thompson
Linda C
LC
Wendell
N Stevenson
NS
Potter
Corey
C
Fehnel
Janet
J
Wilterdink
Brian
B
Silver
Karen
K
Furie
D000328:Adult; D001921:Brain / Q000098:blood supply*; D001926:Brain Death / Q000175:diagnosis / Q000000981:diagnostic imaging*; D001930:Brain Injuries / Q000150:complications; D002552:Cerebral Ventricles / Q000601:surgery*; D056424:Decompressive Craniectomy; D003951:Diagnostic Errors; D004322:Drainage / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012886:Skull / Q000293:injuries*; D013345:Subarachnoid Hemorrhage / Q000150:complications; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*