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| NEUROIMAGES |
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| Year : 2017 | Volume
: 65
| Issue : 3 | Page : 671-672 |
Transcranial Doppler flow patterns in brain death: “Storm before the calm”
Ramanan Rajagopal, Ankush Gupta
Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| Date of Web Publication | 9-May-2017 |
Correspondence Address:
Ramanan Rajagopal
Department of Neurological Sciences, Christian Medical College, Vellore - 632 004, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/neuroindia.NI_779_16
How to cite this article:
Rajagopal R, Gupta A. Transcranial Doppler flow patterns in brain death: “Storm before the calm”. Neurol India 2017;65:671-2 |
The usual method to confirm brain death in a critical care setup consists of the most familiar apnea testing, which is usually done 6 hours after the loss of brainstem reflexes. However, an earlier diagnosis of the same could be made using ancillary testing methods. Transcranial Doppler (TCD) has widely gained acceptance in this aspect because it is noninvasive and can be used at the bedside.[1],[2] Compared to a normal flow pattern, brain-dead patients demonstrate a reverberating flow pattern or short systolic spikes, as the intracranial pressure (ICP) overshoots first the diastolic followed by the systolic blood pressure.[3],[4]
Here, we present a case of severe traumatic brain injury that subsequently progressed to brain death. The serial blood flow velocities of the middle cerebral artery showed a progression from normal flow velocities to an oscillating flow pattern and ultimately to short systolic spikes, as one would expect in brain death. However, surprisingly, at the onset of oscillating flow patterns, we detected higher systolic flow velocities exceeding 150 cm/s, with no diastolic flow velocity, confirming cerebral circulatory arrest [Figure 1]. The patient underwent an apnea test later, which was confirmed to be positive. Hence, we would like to highlight the fact that such high velocities could still be suggestive of brain death when the oscillating flow pattern is seen. | Figure 1: TCD flow patterns. (a) Normal flow pattern. (b) Oscillating flow pattern with high systolic velocities of up to 160 cm/s, and no diastolic flow. (c) Short systolic spikes
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Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| » References | |  |
| 1. | Sharma D, Souter MJ, Moore AE, Lam AM. Clinical experience with transcranial Doppler ultrasonograpy as a confirmatory test for brain death: A retrospective analysis. Neurocrit Care 2011;14:370-6.  [ PUBMED] |
| 2. | Marninoni M, Alari F, Mastronardi V, Peris A, Innocenti P. The relevance of early TCD monitoring in the intensive care units for the confirming of brain death diagnosis. Neurol Sci 2011;32:73-7. |
| 3. | Hassler W, Steinmetz H, Gawlowski J. Transcranial Doppler ultrasonography in raised intracranial pressure and in intracranial circulatory arrest. J Neurosurg 1988;68:745-51. [ PUBMED] |
| 4. | Eder KE, Haussen DC, Searls DE, Henninger N. Reverberating TCD flow pattern in brain death. Neurology 2012;79:e79. [ PUBMED] |
[Figure 1]
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