Assessment of brain perfusion as a part of brain death diagnosis – case reports
Authors:
Drahoslava Nováková; Otakar Kraft; Radoslava Drozdková
Authors‘ workplace:
Klinika nukleární medicíny, FN Ostrava
Published in:
NuklMed 2012;1:75-78
Category:
Casuistry
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
Sources
1. Nařízení vlády č.436/2002 [online].[cit. 2012-07-13]. Dostupné na: http://aplikace.mvcr.cz/archiv2008/sbirka/2002/sb153-02.pdf
2. Vyhláška MZ č. 437/2002 Sb. [online].[cit. 2012-07-13]. Dostupné na: http://aplikace.mvcr.cz/archiv2008/sbirka/2002/sb153-02.pdf
3. Vyhláška MZ č. 479/2002 Sb. [online].[cit. 2012-07-13]. Dostupné na: http://aplikace.mvcr.cz/archiv2008/sbirka/2002/sb166-02.pdf
4. Zákon o darování, odběrech a transplantacích tkání a orgánů a o změně některých zákonů (transplantační zákon) č. 285/2002 Sb. [online].[cit. 2012-07-13]. Dostupné na: http://portal.gov.cz/app/zakony/zakonPar.jsp?idBiblio=53599&nr=285~2F2002&rpp=15
5. Zákon č. 228/2005 Sb. [online].[cit. 2012-07-13]. Dostupné na: http://www.kst.cz/web/download/zakon_228.pdf
6. Národní registr osob nesouhlasících s posmrtným darováním tkání a orgánů [online].[cit. 2012-07-13]. Dostupné na: www.nrod.cz
7. MINISTERSTVO ZDRAVOTNICTVÍ ČR. Standardy zdravotní péče. „Národní radiologické standardy – Nukleární medicína“. Soubor doporučení a návod pro tvorbu místních radiologických postupů (standardů) na diagnostických a terapeutických pracovištích nukleární medicíny v České republice. Věstník MZ ČR. Praha, 2011;9:142-144 [online].[cit. 2012-07-13]. Dostupné na: http://www.mzcr.cz/Legislativa/dokumenty/vestnik-c9/2011_5340_2162_11.html
8. Spieth ME, Devadas GC, Gauger BS. Procedure guidelines for brain death scintigraphy. J Nucl Med 2004;45:922
9. Spieth ME, Ansari AN, Kawada TK. Direct comparison of Tc-99m DTPA and Tc-99m HMPAO for the evaluation of brain death. Clin Nucl Med 1994;19:867-872
10. Mrhač L, Zakko S, Parikh Y. Brain death: the evaluation of semiquan- titative parameters and other signs in HMPAO scintigraphy. Nucl Med Commun 1995;16:1016-1020
11. Bonetti MG, Ciritella P, Valle G et al. 99mTc HM-PAO brain perfusion SPECT in brain death. Neuroradiology 1995;37:365-369
12. Facco E, Zucchetta P, Munari M et al. 99mTc-HMPAO SPECT in the diagnosis of brain death. Intensive Care Med 1998;24:911-917
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