Hot nose sign

Last revised by Ian Bickle on 28 Dec 2021

The hot nose sign refers to increased perfusion in the nasal region on nuclear medicine cerebral perfusion studies in the setting of brain death. The absent or reduced flow in the internal carotid arteries is thought to lead to increased flow within the external carotid arteries and subsequent increased perfusion in the nasal region 1.

Practical points

Although the sign is cute, it is not of any real diagnostic value. The medicolegal importance of brain death is such that direct assessment of cerebral perfusion is required for diagnosis irrespective of how hot or cold the nose may appear.

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Cases and figures

  •  Case 1: hot nose sign
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  • Case 2
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  • Case 3
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  • Case 4
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