TABLE 1 - uploaded by Adnan Kabaalioğlu
Content may be subject to copyright.
Ages, gender, and causes of brain death of patients
Source publication
In this study, we investigated the blood flow velocity changes in orbital arteries by using Doppler sonography in eight patients with brain death. Peak-systolic and end-diastolic velocities and resistive indices of the ophthalmic and central retinal arteries were evaluated. We observed the absence or reversal of end-diastolic blood flow in these ar...
Context in source publication
Context 1
... Society of Neuroradiology were evaluated. Patient age and gender and causes of brain death are presented in Table 1. The diagnosis of brain death was based on clinical (deep coma status, absence of sponta- neous breathing, and brain stem reflexes) and EEG (electro- cerebral silence) findings. ...
Similar publications
In Russia brain death diagnostic is still under great public attention. In such environment confirmatory tests are absolutely necessary. Aim of our study is to investigate the cerebral blood flow in brain death using color-coded duplex sonography. The sonographic study of 20 patients with brain death was performed and included transcranial and extr...
Citations
... In BD, the P1 peak is low because there is no rapid increase in cerebral blood volume or consequent rapid increase in cerebrospinal fluid volume. In contrast, P2 and P3 peaks may stay high since there is no rapid venous outflow [30]. However, in our data, we could not see an increase in the P2/P1 ratio, probably because ICP has reached an extremely high value and no more intracranial volume changes are seen during the cardiac cycle. ...
Background:
Due to the importance of not mistaking when determining the brain death (BD) diagnostic, reliable confirmatory exams should be performed to enhance its security. This study aims to evaluate the intracranial pressure (ICP) pulse morphology behavior in brain-dead patients through a noninvasive monitoring system.
Methods:
A pilot case-control study was conducted in adults that met the BD national protocol criteria. Quantitative parameters from the ICP waveforms, such as the P2/P1 ratio, time-to-peak (TTP) and pulse amplitude (AMP) were extracted and analyzed comparing BD patients and health subjects.
Results:
Fifteen patients were included, and 6172 waveforms were analyzed. ICP waveforms presented substantial differences amidst BD patients when compared to the control group, especially AMP, which had lower values in patients diagnosed with BD (p < 0.0001) and the TTP median (p < 0.00001), but no significance was found for the P2/P1 ratio (p = 0.8). The area under curve for combination of parameters on the BD prediction was 0.77.
Conclusions:
In this exploratory study, noninvasive ICP waveforms have shown potential as a screening method in patients with suspected brain death. Future studies should be carried out in a larger population.
... In BD, the P1 peak is low because there is no rapid increase in cerebral blood volume or consequent rapid increase in cerebrospinal fluid volume. In contrast, P2 and P3 peaks may stay high since there is no rapid venous outflow [25]. However, in our data, we could not see an increase in the P2/P1 ratio, probably because ICP has reached an extremely high value and no more intracranial volume changes are seen during the cardiac cycle. ...
Background: Due to the importance of brain death (BD) diagnostic do not mistake, reliable confirmatory exams should be performed to enhance its security. This study aims to evaluate the intracranial pressure (ICP) pulse morphology behavior in brain-dead patients through a noninvasive monitoring system. Methods: A pilot case-control study was conducted in adults that met the BD national protocol criteria. Quantitative data from the ICP waveforms were extracted and analyzed comparing BD patients and health subjects. Results: Fifteen patients were included. ICP waveforms presented substantial differences amidst BD patients when compared to the control group. Moreover, pulse amplitude and time to peak variables values in the case group were also statistically significant. Conclusions: In this exploratory study, noninvasive ICP waveforms have shown potential as a screening method in patients with suspected brain death. Future studies should be carried out in a larger population.
... The simplest definition of brain death is failure to provide effective cerebral circulation (12). This irreversible condition leads to complete termination or impairment of brain function, including the brainstem, whereas the blood continues to circulate in other parts of the body (1,6). Correct and quick diagnosis of brain death is very important and plays an essential role in the decision making of organ donation for transplantation or withdrawal of life-support (11). ...
... Neurological examination is quite important for the determination of brain death, and, is usually performed by a neurologist or a neurosurgeon. The patients are in a deeply comatose state and brain stem reflexes are absent (6). Nevertheless, in many countries, the diagnosis of brain death necessitates confirmatory tests (11). ...
... Four vessel digital subtraction angiography (DSA), radionuclide cerebral angiography (RCA), computed tomographic cerebral angiography (CTA), transcranial Doppler ultrasonography (TDUS), carotid Doppler ultrasonography (CDUS), serial electroencephalograms (EEG), and brainstem auditory evoked potentials (BAEP) are among these tests (1). The last two tests can be used to detect loss of electrical activity of the brain (electrocerebral silence) and the others are used to evaluate cerebral blood flow (6,11). These confirmatory tests, however, have many limitations and disadvantages. ...
It remains unknown whether orbital Doppler-ultrasound (ODUS) could be an alternative to other established ancillary tests for the diagnosis of brain death. We investigated the effectiveness of ODUS in the diagnosis of brain death and compared data obtained from ODUS with transcranial Doppler-ultrasound (TDUS) and carotid Doppler-ultrasound (CDUS) findings.
ODUS, CDUS and TDUS examinations were performed on 22 consecutive patients who had clinical examination and confirmatory test findings consistent with brain death. The compatibility of resistive indices (RI) from ODUS, TDUS and CDUS examinations were analyzed.
In ODUS examinations, the RI values were equal to or greater than one in 15 patients (68%). In the remaining 7 patients, the RI values were ≥0.75. RI values were ≥ 1 in 16 (72%) and 18 (82%) patients in CDUS and TDUS examinations, respectively. RI values of CDUS and TDUS were ≥0.76 in the remaining patients.
ODUS is an easily applicable technique that is safer, cheaper and faster when compared with the other confirmatory tests. False results could be prevented by evaluating patients with an ODUS RI value of < 1 together with the TDUS and/or CDUS results.
... Підвищення швидкісних показників реєструється при запальних станах, наприклад при невриті зорового нерва [24]. Є публікації, автори яких стверджують, що за даними допплерографії артерій очного яблука можна оцінювати стан життєздатності центральної нервової системи, в тому числі констатувати смерть мозку [25]. ...
... 295,294,304 Karen Ann Quinlan's brain showed severe damage of the thalamus, with the cerebral hemispheres relatively spared, 298 and other authors have reported similar findings. [305][306][307][308][309] We can ask ourselves if, in a case like this, other activating pathways, projecting to the cerebral cortex without relaying through the thalamus, could stimulate the cerebral cortex to provide internal awareness, even if physicians are unable to detect its manifestations. 14 Unexpected and well-documented recoveries of cognitive functions have been described in patients diagnosed by neurologists experienced and skilled in the diagnosis of this condition. ...
This text is intended to provide an overview of the processes of brain death. The topics explored in this book include the concepts and historical approach of human death, clinical examinations of brain-dead patients, ancillary tests in coma and brain death, bioethical discussions of brain death and its relationship with some consciousness disturbances, and the legal considerations of human death. While there are several books devoted to the study of specific issues of brain death, this book encompasses a wide spectrum of issues including medical, legal, bioethical and historical aspects. © 2007 Springer Science+Business Media, LLC. All rights reserved.
... The posterior circulation should also be insonated, especially in patients with cerebellar pathology. There are additionally reports of Doppler studies of the ophthalmic arteries correlating with signs of brain death [103]. ...
Transcranial Doppler (TCD) ultrasonography is a technique that uses a hand-held Doppler transducer (placed on the surface of the cranial skin) to measure the velocity and pulsatility of blood flow within the intracranial and the extracranial arteries. This review critically evaluates the evidence for the use of TCD in the critical care population.
TCD has been frequently employed for the clinical evaluation of cerebral vasospasm following subarachnoid haemorrhage (SAH). To a lesser degree, TCD has also been used to evaluate cerebral autoregulatory capacity, monitor cerebral circulation during cardiopulmonary bypass and carotid endarterectomies and to diagnose brain death. Technological advances such as M mode, colour Doppler and three-dimensional power Doppler ultrasonography have extended the scope of TCD to include other non-critical care applications including assessment of cerebral emboli, functional TCD and the management of sickle cell disease.
Despite publications suggesting concordance between TCD velocity measurements and cerebral blood flow there are few randomized controlled studies demonstrating an improved outcome with the use of TCD monitoring in neurocritical care. Newer developments in this technology include venous Doppler, functional Doppler and use of ultrasound contrast agents.
... Normal and abnormal flow patterns of orbital vessels were described by Erickson et al in 1989 (2). Since then, orbital blood flow changes have been demonstrated in various disorders, such as glaucoma (3), Behçet disease (4), and brain death (5). The purpose of our study was to evaluate orbital blood flow velocities with Doppler sonography in patients with acute unilateral optic neuritis. ...
To evaluate orbital blood flow velocities with Doppler sonography in patients with acute unilateral optic neuritis.
Orbital Doppler sonography was performed in 20 patients with acute unilateral optic neuritis. Optic neuritis was diagnosed by a neurologist on the basis of clinical presentation, presence of decreased visual acuity, and assessment of visual evoked potentials. The peak systolic and end diastolic velocities and the resistive index were measured in the ophthalmic and central retinal arteries of both orbits. The values obtained from affected and unaffected orbits were compared by using the paired t test.
The peak systolic and end diastolic velocities in the ophthalmic artery were significantly increased in the affected orbits (for peak systolic velocity P <.001, for end diastolic velocity P <.05). Resistive indexes in the ophthalmic arteries did not differ (P >.05). The difference between the peak systolic and end diastolic velocities and resistive indexes in the central retinal arteries of affected and normal eyes was not statistically significant (P >.05).
Peak systolic and end diastolic velocities in the ophthalmic artery are increased in patients with acute optic neuritis.
... The orbital Doppler sonographic examination in 8 brain-dead patients revealed the absence or reversal end-diastolic blood flow in ophthalmic arteries (21), although the peak-systolic velocity was present in all 8 patients. ...
... There is no rapid increase in CBV or consequent rapid decrease in CSF volume, so the P1 sub-wave peak is low. There is no rapid venous outflow or it is nega-tive, as demonstrated in on orbital Doppler study (21), so the P2 and P3 sub-wave peaks stay high. ...
Objective. To evaluate changes in ultrasonic pulse waves using the trans-intracranial volume-metric device (Vittamed Ltd., USALithuania U.S. patent No. 5388583, European patent 0717606) in patients with diagnosed brain death. Material and methods. Eight patients (6M, 2F, age range 3759 years, mean age 47.4 ± 10.5 years) with the clinically and radioisotopically confirmed brain death were assessed with the trans-intracranial ultra-sound and pulse waves acquired. The analysis of ultrasound pulses am-plitude and waveforms was performed and then compared to the data of 34 healthy volunteers (21M, 13F, age range 875 years, mean age 31.3 ± 18.4 years). Results. The non-invasively measured pulse wave amplitude in the brain death group was 1.55 ± 0.6 ns, compared to 4.04 ± 2.48 ns in the control group (p = 0.00001). The pulse sub-waves from brain death patients demonstrated a P1 value of 79.7 ± 16.3%, P2 value of 84.0 ± ±14.8%, and P3 value of 85.9 ± 14.1%. The same values calculated in the control group were 97.2 ± 4.3%, 68.3 ± 22.5% and 39.6 ± 26.5%, respectively. The differences between the groups were statistically signi-ficant (p < 0.05). Conclusion. The association of abnormal pulse waves and low amplitude may strongly suggest brain death, providing the diagnostic information for future manipulations.
Objective:
The purpose of this observational study is to explore if bedside Doppler ultrasonography of the central retinal vessels has the potential to become an ancillary study to support the timely diagnosis of brain death in children.
Design:
Seventeen-month prospective observational cohort.
Setting:
Forty-four bed pediatric medical and surgical ICU in an academic teaching hospital.
Patients:
All children 0-18 years old who were clinically evaluated for brain death at Children's National Health Systems were enrolled and followed until discharge or death.
Interventions:
None.
Measurements and main results:
All patients had at least one ophthalmic ultrasound within 30 minutes of each brain death examination. The central retinal artery peak systolic blood flow velocity, resistive index, pulsatility index, and Doppler waveforms were evaluated in each patient. Thirty-five ophthalmic ultrasounds were obtained on 13 patients, 3 months to 15 years old, who each had two clinical examinations consistent with brain death. The average systolic blood pressure during the ultrasound examinations was 102 mm Hg (± 28), diastolic blood pressure 65 mm Hg (± 24), mean arterial pressure 79 mm Hg (± 23), heart rate 133 beats/min (± 27), temperature 36°C (± 0.96), arterial CO2 35 mm Hg (± 9), and end-tidal CO2 23 mm Hg (± 6). For all examinations, the average peak systolic velocity of the central retinal artery was significantly decreased at 4.66 cm/s (± 3.2). Twelve of 13 patients had both resistive indexes greater than or equal to 1, average pulsatility indexes of 3.6 (± 3.5) with transcranial Doppler waveforms consistent with brain death. Waveform analysis of the 35 ultrasound examinations revealed 11% with tall systolic peaks without diastolic flow, 17% with oscillatory flow, 29% showed short systolic spikes, and 23% had no Doppler movement detected. A rippling "tardus-parvus" waveform was present in 20% of examinations.
Conclusion:
This study supports that the combination of qualitative waveform analysis and quantitative blood flow variables of the central retinal vessels may have the potential to be developed as an ancillary study for supporting the diagnosis of brain death in children.
