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Table of Contents    
Year : 2017  |  Volume : 65  |  Issue : 4  |  Page : 912

Importance of evaluating posterior circulation flow to confirm brain death

Neuro Intensive Care Unit, Christian Medical College, Vellore, Tamil Nadu, India

Date of Web Publication5-Jul-2017

Correspondence Address:
Shalini Nair
Neuro ICU, Christian Medical College, Vellore, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/neuroindia.NI_1185_16

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How to cite this article:
Rajagopal R, Nair S. Importance of evaluating posterior circulation flow to confirm brain death. Neurol India 2017;65:912

How to cite this URL:
Rajagopal R, Nair S. Importance of evaluating posterior circulation flow to confirm brain death. Neurol India [serial online] 2017 [cited 2020 Sep 30];65:912. Available from:

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 1: Middle cerebral artery flow

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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.[1] 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.[1] This report reiterates the fallacy of insonating only the anterior circulation.

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There are no conflicts of interest.

  References Top

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.  Back to cited text no. 1


  [Figure 1], [Figure 2]


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