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Brain Death
Akiva Mintz, MD, PhD, MHA, CFA; Tejaswini Vasamsetty, MD
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KEY FACTS

  • Terminology

    • Imaging

      TERMINOLOGY

      • Definitions

        • Brain death (BD) is complete, irreversible cessation of brain function
        • Legal definition (as based from draft form of Uniform Determination of Death Act)
        • Legal definition of brain death
          • Irreversible cessation of circulatory and respiratory functions
          • Irreversible cessation of all functions of entire brain, including brainstem
        • Most facilities require 2 independent clinical confirmations of brain death
        • Primarily a clinical diagnosis
          • Ancillary studies used when clinical picture equivocal &/or to shorten length of observation period
        • Brain death diagnosis important for organ donation status
        • Imaging may confirm brain death but does not substitute for clinical criteria

      IMAGING

      • General Features

        • Nuclear Medicine Findings

          • CT Findings

            • Angiographic Findings

              • MR Findings

                • Ultrasonographic Findings

                  • Other Modality Findings

                    • Imaging Recommendations

                      • Artifacts and Quality Control

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      Selected References

                                      1. Donohoe KJ et al: SNM practice guideline for brain death scintigraphy 2.0. J Nucl Med Technol. 40(3):198-203, 2012
                                      2. Wijdicks EF et al: Evidence-based guideline update: determining brain death in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 74(23):1911-8, 2010
                                      3. Booth CM et al: Is this patient dead, vegetative, or severely neurologically impaired? Assessing outcome for comatose survivors of cardiac arrest. JAMA. 291(7):870-9, 2004
                                      4. Belber CJ: Brain death documentation: analysis and issues. Neurosurgery. 53(4):1009; author reply 1009, 2003
                                      5. Conrad GR et al: Scintigraphy as a confirmatory test of brain death. Semin Nucl Med. 33(4):312-23, 2003
                                      6. Donohoe KJ et al: Procedure guideline for brain death scintigraphy. J Nucl Med. 44(5):846-51, 2003
                                      7. Harding JW et al: Outcomes of patients referred for confirmation of brain death by 99mTc-exametazime scintigraphy. Intensive Care Med. 29(4):539-43, 2003
                                      8. Flowers WM Jr et al: Accuracy of clinical evaluation in the determination of brain death. South Med J. 93(2):203-6, 2000
                                      9. Haupt WF et al: European brain death codes: a comparison of national guidelines. J Neurol. 246(6):432-7, 1999
                                      10. Pisani F et al: Sodium valproate and valpromide: differential interactions with carbamazepine in epileptic patients. Epilepsia. 27(5):548-52, 1986
                                      11. Young GB: Diagnosis of brain death.  UpToDate Web site. http://www.uptodate.com/contents/diagnosis-of-brain-death. Updated May 17, 2012. Accessed February 10, 2015
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          TERMINOLOGY

                                          • Definitions

                                            • Brain death (BD) is complete, irreversible cessation of brain function
                                            • Legal definition (as based from draft form of Uniform Determination of Death Act)
                                            • Legal definition of brain death
                                              • Irreversible cessation of circulatory and respiratory functions
                                              • Irreversible cessation of all functions of entire brain, including brainstem
                                            • Most facilities require 2 independent clinical confirmations of brain death
                                            • Primarily a clinical diagnosis
                                              • Ancillary studies used when clinical picture equivocal &/or to shorten length of observation period
                                            • Brain death diagnosis important for organ donation status
                                            • Imaging may confirm brain death but does not substitute for clinical criteria

                                          IMAGING

                                          • General Features

                                            • Nuclear Medicine Findings

                                              • CT Findings

                                                • Angiographic Findings

                                                  • MR Findings

                                                    • Ultrasonographic Findings

                                                      • Other Modality Findings

                                                        • Imaging Recommendations

                                                          • Artifacts and Quality Control

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                • Gross Pathologic & Surgical Features

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Demographics

                                                                      • Natural History & Prognosis

                                                                        DIAGNOSTIC CHECKLIST

                                                                        • Consider

                                                                          Selected References

                                                                          1. Donohoe KJ et al: SNM practice guideline for brain death scintigraphy 2.0. J Nucl Med Technol. 40(3):198-203, 2012
                                                                          2. Wijdicks EF et al: Evidence-based guideline update: determining brain death in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 74(23):1911-8, 2010
                                                                          3. Booth CM et al: Is this patient dead, vegetative, or severely neurologically impaired? Assessing outcome for comatose survivors of cardiac arrest. JAMA. 291(7):870-9, 2004
                                                                          4. Belber CJ: Brain death documentation: analysis and issues. Neurosurgery. 53(4):1009; author reply 1009, 2003
                                                                          5. Conrad GR et al: Scintigraphy as a confirmatory test of brain death. Semin Nucl Med. 33(4):312-23, 2003
                                                                          6. Donohoe KJ et al: Procedure guideline for brain death scintigraphy. J Nucl Med. 44(5):846-51, 2003
                                                                          7. Harding JW et al: Outcomes of patients referred for confirmation of brain death by 99mTc-exametazime scintigraphy. Intensive Care Med. 29(4):539-43, 2003
                                                                          8. Flowers WM Jr et al: Accuracy of clinical evaluation in the determination of brain death. South Med J. 93(2):203-6, 2000
                                                                          9. Haupt WF et al: European brain death codes: a comparison of national guidelines. J Neurol. 246(6):432-7, 1999
                                                                          10. Pisani F et al: Sodium valproate and valpromide: differential interactions with carbamazepine in epileptic patients. Epilepsia. 27(5):548-52, 1986
                                                                          11. Young GB: Diagnosis of brain death.  UpToDate Web site. http://www.uptodate.com/contents/diagnosis-of-brain-death. Updated May 17, 2012. Accessed February 10, 2015