Brain death

Case contributed by Dr Mohamed Mahmoud Elthokapy

Presentation

Prolonged cardiac arrest with ineffective multiple CPR trials

Patient Data

Age: 80 years
Gender: Male
CT

Significant generalized low attenuation of the entire brain parenchyma and to less extent cerebellum suggesting global brain anoxia.

Evidence of diffuse cerebral edema with effacement of the grey-white matter borders and marked effacement of the brain sulci as well as major cisterns.

Non-visualized the ventricular system (markedly attenuated) with evidence of tonsillar cerebellar herniation.

The grey-white matter interface has been lost as well.

Associated hyper-density is noted within the basal cisterns and effaced sulci more at the left posterior parietal region giving the appearance of pseudo-subarachnoid hemorrhage.

There is a right posterior-inferior cerebellar small hyperdense lesion seen likely

hemorrhagic transformation.

Marked opacification of the nasopharynx, nasal cavity, and posterior paranasal sinuses secondary to retained secretions.

ETT was seen also in the oral cavity.

Case Discussion

A typical case of global brain anoxia with pseudo-subarachnoid hemorrhage. Consequent diffuse brain edema and swelling with associated increased intracranial pressure results in tonsilar herniation

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