|Year : 2017 | Volume
| Issue : 4 | Page : 912
Importance of evaluating posterior circulation flow to confirm brain death
Ramanan Rajagopal, Shalini Nair
Neuro Intensive Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
|Date of Web Publication||5-Jul-2017|
Neuro ICU, Christian Medical College, Vellore, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Rajagopal R, Nair S. Importance of evaluating posterior circulation flow to confirm brain death. Neurol India 2017;65:912
A 47-year old gentleman presented 8 hours after an alleged history of a road traffic accident. At presentation, his pupils were 4 mm and nonreactive to light. All other reflexes except cough reflex on repeated deep suction were absent. A transcranial Doppler (TCD) showed the typical reverberating flow pattern in the middle cerebral artery [Figure 1]. However, there was normal blood flow in the posterior circulation. The pattern persisted till the cough reflex was absent. The vertebral artery flow also changed to the reverberating pattern at this time [Figure 2]a and [Figure 2]b.
|Figure 2: (a) Vertebral artery flow when cough reflex is present; (b) vertebral artery flow after cough reflex is lost|
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TCD plays a vital role as an ancillary test to confirm brain death when clinical testing cannot be completed due to patient-related factors. Confirmation of flow patterns in both circulations in such circumstances is of vital importance.
Appendix 1 of American Academy of Neurology guideline update on determining brain death using transcranial Doppler (TCD) stresses the importance of insonation of both anterior and posterior circulations, bilaterally. This report reiterates the fallacy of insonating only the anterior circulation.
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| » References|| |
Wijdicks EFM, Varelas PN, Gronseth GS, Greer DM. Evidence- based guideline update: Determining brain death in adults. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2010;74:1911-8.
[Figure 1], [Figure 2]