Presentation
Motor vehicle collision trauma patient. Remainder withheld.
Patient Data
Age: 20 years
Gender: Male
From the case:
Brain death after motor vehicle collision
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Anterior and lateral planar views from a Tc99m-HMPAO brain death study demonstrate complete lack of intracranial uptake (empty light bulb sign). Non-specific, incidental, "hot nose sign" is also demonstrated. Note that the "hot nose" actually corresponds central upper cervical uptake on lateral images, it is often misattributed to external carotid artery uptake in the nasal soft tissues.
From the case:
Brain death after motor vehicle collision
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Axial non-contrast CT demonstrates a large, holohemispheric, right subdural hematoma, with significant right to left midline shift, and areas of uncal, sub-falcine, trans-tentorial, and tonsillar herniation.
Case Discussion
Key Points:
- lipophilic perfusion agents like 99mTc-HMPAO and 99mTc-ECD cross the blood-brain barrier and should be taken up by perfusing brain parenchyma. They also allow for more delayed imaging, including SPECT imaging.
- hydrophilic perfusion agents like 99mTc-DTPA are flow agents that do not cross the blood-brain barrier, so tight bolus and imaging timing is required to demonstrate intracranial flow.
- brain death scans are an adjunctive confirmatory tool to appropriate clinical diagnosis of brain death. They do not diagnose brain death.
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