Publication: Transcranial Doppler Imaging; A simple Guide for Brain Death Before CT Angiography
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Date
2023-05-07
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Abstract
Introduction: Ancillary tests can be used for the diagnosis of brain
death in cases wherein uncertainty exists regarding the neurological
examination and apnoea test cannot be performed. Transcranial Doppler
ultrasonography (TCD) is a useful, valid, non-invasive, portable, and
repeatable ancillary test for the confirmation of brain death. The purpose
of this case is to represent the utility of transcranial Doppler as an ancillary
test in brain death confirmation.
Case: A 32-year-old male patient was admitted to intensive care unit after
DSA intervention due to middle cerebral artery (MCA) aneurysm. In the
intensive care follow-ups, sedation vacation attempted, however his brain
stem reflexes were absent, he had no respiratory effort, GCS score was 3,
pupils were fixed dilated. The patient’s hemodynamic status remained
stable throughout the ICU stay, only requiring low-dose norepinephrine
for less than 12 hour. Neurological examination showed the absence of
the corneal, gag, oculovestibular, and cough cranial reflexes. The apnea
test was positive and then secondly TCD performed. Cerebral blood flow
cessation detected and oscillating flow waves observed in MCA, anterior
cerebral artery (ACA), posterior cerebral artery (PCA), basilar and vertebral
arteries. We determined when to perform CT angiography (CTA) with light
of TCD. Brain death was confirmed according to CTA results.
Discussion: TCD ultrasonography, one of the ancillary bedside tests
for brain death, is a non-invasive, reproducible method. Despite its
limitations, TCD helps solve common diagnostic problems, avoids the
unnecessary consumption of resources. It is inevitable that intensivists
will gradually increase the use of TCD ultrasonography in the diagnosis of
brain death in the near future due to its advantages.
Keywords: Transcranial doppler USG, brain death, CT angiography,
cerebral blood flow
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Keywords
Transcranial doppler USG, brain death, CT angiography, cerebral blood flow
Citation
YILDIZ ÜSTÜN B., KASAPOĞLU U. S., Aliyev K., Özaydın K., GÜL F., \"Transcranial Doppler Imaging; A simple Guide for Brain Death Before CT Angiography\", 24th International Intensive Care Symposium, Türkiye, 5 - 06 Mayıs 2023, cilt.21, ss.60