Considerations of Brain Death on a SPECT Cerebral Perfusion Study

Valle, Guido; Ciritella, P; Bonetti, M.G.; Dicembrino, Franca; Perrone, Elio; Perna, Gian Piero

doi:10.1097/00003072-199311000-00004

Cited by 21 publications

(9 citation statements)

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“…Typical pathology of brain death shows a swelling from a hemispheric lesion that eventually raises the intracranial pressure above the perfusion pressure. The tentorium momentarily protects the cerebellum from the rising pressure, thereby leading to visualization of the posterior fossa when radionuclide brain perfusion is performed early as observed in 1 patient in this study and also previously reported by others [7,8,21].…”

Section: Discussionsupporting

confidence: 83%

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Confirmation of Brain Death Using Brain Radionuclide Perfusion Imaging Technique

Al-Shammri

Alfeeli²

2004

Med Princ Pract

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Objective: To determine the reliability of radionuclide cerebral blood perfusion imaging in confirming brain death irrespective of continued heartbeat. Subjects and Methods: Twenty-eight patients (19 male and 9 female, aged 17–63 years) with severe brain injury and fully supported until the final cardiac asystole were included in the study. Two sets of clinical tests aimed at ascertaining brain death in each subject were performed separately for each case within an interval of 24 h. Dynamic, planar and single photon emission computed tomographic (SPECT) brain scintigraphy were also performed after intravenous administration of 550 MBq (15 mCi) technetium-99m hexamethyl propyleneamine oxime. Results: Following the clinical diagnosis of brain death, none of the patients was withdrawn from cardiopulmonary support or had any organ harvested. Dynamic, planar and SPECT imaging performed thereafter did not reveal any intracranial cerebral perfusion in any of the subjects, except in 1 patient where the initial scan showed posterior fossa activity that ceased, in a subsequent scan obtained after 24 h. All of the patients were declared dead only after the emergence of cardiac asystole. Conclusion: The findings indicate that radionuclide brain perfusion imaging is reliable, reproducible, noninvasive and simple to perform for the confirmation of brain death and as such we recommend it as an alternative to exhaustive neurophysiological tests and invasive catheter angiography.

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Section: Discussionsupporting

confidence: 83%

“…The use of radionuclide cerebral perfusion imaging studies in the confirmation of the clinical criteria for the diagnosis of brain death have been reported previously [6][7][8][9]. This study confirms the reliability of dynamic, planar and SPECT imaging for the diagnosis of brain death.…”

Section: Discussionsupporting

confidence: 81%

Confirmation of Brain Death Using Brain Radionuclide Perfusion Imaging Technique

Al-Shammri

Alfeeli²

2004

Med Princ Pract

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“…Contradictory findings of preserved infratentorial/cerebellar perfusion with absent cerebral (supratentorial) perfusion are rare. Valle et al 3 called such findings "a step in the brain death phenomenon" and felt that brain death could not be confirmed under these circumstances. 3 Others have found that death results within hours to days after the findings in such patients.…”

Section: Introductionmentioning

confidence: 99%

“…Valle et al 3 called such findings "a step in the brain death phenomenon" and felt that brain death could not be confirmed under these circumstances. 3 Others have found that death results within hours to days after the findings in such patients. 2 Radionuclide angiography is a sensitive easily performed test to confirm the clinical diagnosis of brain death but may not adequately evaluate the posterior fossa circulation; an occasional patient may show residual brain stem function on brain scan.…”

Section: Introductionmentioning

confidence: 99%

Technetium-99m ethylene cysteine dimer posterior fossa perfusion and brain death

Joseph¹,

Kothari²,

Skolkin³

et al. 2012

RRNM

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Background:The purpose of this study was to evaluate the frequency of and outcome in patients with isolated posterior fossa uptake on cerebral perfusion scan. Methods: A retrospective review was undertaken of electronic medical records over 6 years from 713 consecutive patients undergoing technetium-99m ethyl cysteine dimer cerebral perfusion scans to identify isolated posterior fossa activity. Results: Of the 13 patients with isolated posterior fossa activity, 10 deteriorated to death and three had life support withdrawn. They survived an average of 0.24 day ± 0.27 standard deviation (SD) days after scanning and an average of 1.03 ± 0.33 SD days on life support. Conclusion: Unilateral or bilateral isolated posterior fossa technetium-99m ethyl cysteine dimer activity indicates imminent or impending brain death and a poor prognosis.

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“…Among cerebral blood flow tests, Doppler ultrasonography, contrast angiography and planar scintigraphy have been widely used in the past [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. By contrast, only a few studies on small series or case reports have been published so far on single photon emission tomography (SPECT) in the diagnosis of BD [23][24][25][26][27]. The aim of this study is to check the effectiveness of SPECTwith 99mTc-HMPAO in a larger sample.…”

Section: Introductionmentioning

confidence: 99%