Brain death

Case contributed by Dr Bruno Di Muzio

Presentation

Motor vehicle accident: pedestrian vs. truck 10 days ago. Major abdominal and pelvic lesions. Evolving with seizures and fever in the ICU.

Patient Data

Age: 20-year-old
Gender: Female
CT

CT Brain

 

There is new global effacement of the sulci in both cerebral hemispheres as well as the sylvian fissures bilaterally. No acute intracranial haemorrhage or cortical infarct. Grey-white differentiation is maintained. Normal sulcal and ventricular pattern. No midline shift. No acute fracture or suspicious bony lesion. The imaged paranasal sinuses and mastoid air cells are aerated.

 

MRI

MRI Brain

There is wide diffuse abnormal signal involving all lobes of the hemispheres, characterised by cortical swelling and restricted diffusion (particularly of cortex, subcortical white matter, and deep grey matter - most notably the thalami). Generalised brain swelling is present with effacement of the basal cisterns.

Within the limitations of this scan (which does not include MRV or MRA) dural venous sinuses appear normal, and flow voids are present in the major intracranial arteries.

Air-fluid levels in both sphenoid sinuses. The orbits and calvarium appear unremarkable.

Brain death was considered and was hard to evaluate in the scenario of a large amount of sedation. An angiographic confirmation was proposed. 

DSA (angiography)

DSA - Cerebral angiography

 

No intradural cranial blood flow can be demonstrated, confirming brain death.

Conclusion: Findings indicative of brain death.​

Case Discussion

Brain death refers to the irreversible end of all brain activity and is usually assessed clinically. However, in some cases such as this one, confirmation in made mandatory and DSA angiography figures as one of the options: no forward flow above the terminal ICA, this occurs because the intracranial pressure exceeds the pulse pressure in the carotids and vertebral arteries. 

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Case information

rID: 43754
Case created: 24th Mar 2016
Last edited: 31st May 2017
Tag: rmh
Inclusion in quiz mode: Included

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