What signs of ischaemic brain injury are present?
Pseudosubarachnoid haemorrhage sign; white cerebellum sign; loss of grey-white differentiation; global increased mass effect with cerebral herniation and sulcal effacement.
How is brain death diagnosed?
In Australia, it is a clinical diagnosis based on observation and examination. If the clinical diagnosis cannot be made then brain death can also be diagnosed with cerebral DSA and/or nuclear medicine studies to confirm absence of intracranial blood flow.
There is diffuse oedema and loss of normal grey-white differentiation. Hypoattenuation of the cerebral hemispheres and especially basal ganglia with sparing of the cerebellum is seen along with hyperdense falx cerebri and tentorium cerebelli relative to brain parenchyma, giving the appearance of pseudosubarachnoid haemorrhage. These appearances are consistent with hypoxic- ischaemic brain injury.
There is an increased mass effect with tonsillar and uncal herniation, and slit-like effacement of the lateral and third ventricles. No midline shift or uncal herniation. No intracranial haemorrhage is identified.