Assessment of brain perfusion as a part of brain death diagnosis – case reports

Overview

Brain death is an irreversible discontinuation of all brain functions including a brain stem. According to transplantation law, it is possible to take organs for transplantation if the deceased do not undoubtedly express a disagreement with it during his/her life.

Case reports describe examinations used for the detection and the confirmation of a brain death in patients with a deep uncounsciousness with emphasize to scintigraphy. At present, the only available Tc-99m labeled radiopharmaceuticals which fulfil strict criteria for brain death evaluation are HMPAO and Neurolite.

Case report 1. 35-y-old man suffered a craniotrauma with a severe injury of the right half of the skull with a coma without any reflexes due to a malignant brain edema. Neurological examinations were typical for a brain death. Brain perfusion scintigraphy, however, excludes brain death because of a detection of a flow of a radiopharmaceutical through carotides into the brain. The same result was confirmed 24 hours later.

Case report 2. 62-y-old patient fall due to a sudden dizziness. Brain computed tomography described hemorrhage into the brain supratentorially, into the ventricles and the brain stem. Brain perfusion scintigraphy detected distribution of a radiopharmaceutical into the brain tissue – brain death was impossible to confirm. Scintigraphy performed 24 hours later did not detect any radioactivity in the skull – the result is typical for a brain death.

Case report 3. 7-y-old girl was found in the bath unconscious after an unintentional poisoning with a carbon oxide. Asystole, apnoe, bilateral fixed mydriasis, hypotermia and vomit aspiration were diagnosed. Neurological examination confirm no brain stem reflexes with a deep coma. CT of the brain confirms edema of the brain and cerebellum without a hemorrhage, massive aspiration into both lungs and lung edema. Scintigraphy unequivocally confirm no brain perfusion – finding typical for a brain death.

Key Words:
brain death, scintigraphy, case reports