Presentation
History of previously embolized arteriovenous malformation, currently with severe headache and loss of consciousness.
Patient Data
Opacification of the left internal carotid artery (ICA) only until segment C1, right anterior cerebral artery (ACA) until A2, and both vertebral arteries (VA) until V2.
Cerebral swelling. Subarachnoid, parenchymal and intraventricular hemorrhage.
The following are noted:
- right internal carotid artery flow until C4
- left internal carotid artery flow until C1
- both vertebral arteries flow until V2
Case Discussion
Brain death brain refers to irreversible end of all brain activity, is clinically evaluated, and is confirmed by radiographic studies.
CT angiography:
Dupas et al described the diagnosis of cerebral circulatory arrest by 2-phase helical CT angiography. Spiral CT shows the arrest of contrast medium at the level of the basilar artery, pericallosal artery, terminal arteries for the cortex, internal cerebral vein, great cerebral vein and straight sinus, associated with enhanced visibility of the superior ophthalmic veins.
Leclerc et al concludes that the absence of opacification of cortical branches of the MCA and opacification of the internal cerebral vein are the best criteria for the diagnosis of brain death by CT angiography.
Digital subtraction angiography (DSA) is the gold standard imaging test and should show no forward flow above the terminal internal carotid arteries.
This case demonstrates features of brain death on CT angiography, confirmed by DSA.