Brain death: CT angiography

Case contributed by Dr. Chris O'Donnell

Presentation

Out of hospital cardiac arrest. Resuscitated, not responding cerebrally, ? brain death

Patient Data

Age: 40 years
Gender: Female
CT

Filling of the terminal external carotid artery branches bilaterally (in the scalp) with absent filling of intracranial arteries (carotid or vertebro-basilar).  Note gross brain swelling with loss of grey/white matter, obliteration of ventricles and basal cisterns and pseudo-SAH at the skull base.  Appearances are due to marked hypoxic-ischemic injury and indicate brain death.

Case Discussion

The absence of cerebral blood flow is an important finding - nuclear medicine scintigraphy and catheter angiography have been the mainstay of diagnostic procedures but CTA showing good filling of scalp arteries and no intracranial arterial filling is diagnostic of absent blood flow to the brain - i.e. brain death

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