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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

Correspondence Address:
Ramanan Rajagopal
Department of Neurological Sciences, Christian Medical College, Vellore - 632 004, Tamil Nadu

How to cite this article:
Rajagopal R, Gupta A. Transcranial Doppler flow patterns in brain death: “Storm before the calm”.Neurol India 2017;65:671-672

How to cite this URL:
Rajagopal R, Gupta A. Transcranial Doppler flow patterns in brain death: “Storm before the calm”. Neurol India [serial online] 2017 [cited 2022 May 25 ];65:671-672
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Full Text

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}

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