Brain death on MRI and CT angiography

Case contributed by Dr Chris O'Donnell

Presentation

PH of melanoma resection. Now collapse with status epilepticus. Fixed pupils

Patient Data

Age: 50
Gender: Male
Modality: MRI

Diffuse brain swelling with obliteration of basal cisterns and tonsillar herniation through the foramen magnum but only minor restrcition of diffusion.  The key to this case is the presence of T2 signal in the internal carotid arteries in the carotid canals ie loss of the flow voids.  Recurrence of haemorrhagic melanoma in the anterior brain/genu of the corpus callosum following previous surgical excision.

CT angiography performed 3 hours post MRI to confirm absent cerebral blood flow

Modality: CT

Diffuse brain swelling (loss of grey/white matter differentiation) with absent intracranial blood flow (despite excellent filling of external carotid arterial branches in the scalp (arrows).

Case Discussion

The absence of blood flow to the brain is the mainstay of the radiological diagnosis of brain death.  This can be demonstrated by CT or MR angiography or radioisotope on nuclear medicine.  In this case the loss of internal carotid flow voids on conventional MRI was the clue to brain death.

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Case Information

rID: 42560
Case created: 27th Jan 2016
Last edited: 16th Aug 2016
Inclusion in quiz mode: Included

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