Abstract
DOI: 10.26650/cjm.2019.43.42
Objective: Brain death (BD) implies the
permanent absence of cerebral and brainstem functions. It should be shown that there is no blood
flow in all brain regions even besides the brainstem by using the confirmatory
tests. We aimed to evaluate the incompatibility to diagnosis of BD by clinical
and ancillary tests (computed tomographic angiography (CTA), magnetic resonance
imaging angiography (MRIA), transcranial Doppler ultrasonography (TCD-USG),
electroencephalography (EEG)).
Methods: The patients admitted to our
intensive care unit between 2012-2018 have been evaluated retrospectively.
Twenty two patients who were assessed as BD, and additionally 12 of them had
ancillary tests for BD for certain diagnosis investigated. Demographic data,
causes of BD, and the follow ups were recorded for all patients.
Results: Twelve patients were diagnosed as
BD. The reasons leading to BD were intracranial hemorrhage, cardiac arrest,
intracranial tumours, pulmonary embolism, aneurysmal hemorrhage, menengitis,
subarachnoid hemorrhage. The mean age was 40.86±15.62 years, the mean APACHE II
score was 28.23±16.33. Brain death was diagnosed by clinically in 10 patients,
and 12 patients evaluated by ancillary tests.
Conclusion: Brain death can be diagnosed
based on clinical criteria, but in somehow confirmative tests may be necessary.
Clinically diagnosing of BD is not always consistent with CTA, and procedure is
needed to be repeated or other further techniques have to be used for
confirmation.
Cite this article as: Utku T, Bozbay S,
Ürkmez S, Akçıl EF, Demirkıran O, Dikmen Y. Assessing the consistency of
clinical diagnosis and ancillary tests for brain death. Cerrahpasa Med J 2019;
43(1): 29-33.
References
- 1. The Quality Standards Subcommittee of the American Academy of Neurology. Practice parameters for determining brain death in adults (summary statement). Neurology 1995; 45: 1012-4. 2. Wijdicks EF, Varelas PN, Gronseth GS, Greer DM. Evidence-based guideline update: determining brain death in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2010; 74: 1911-8. 3. Shemie SD, Doig C, Dickens B, Byrne P, Wheelock B, Rocker G, et al. Severe brain injury to neurological determination of death: Canadian forum recommendations. CMAJ 2006; 174: S1-13. 4. Australian and New Zealand Intensive Care Society. The ANZICS Statement on Death and Organ Donation. Edition 3.2. VIC Australia: New Zealand Intensive Care Society; 2013. 5. Academy of Medical Royal Colleges. A code of practice for the diagnosis and confirmation of death. London: Academy of Medical Royal Colleges; 2008. 6. Wijdicks EF. Brain death worldwide: accepted fact but no global consensus in diagnostic criteria. Neurology 2002; 58: 20-5. 7. Heran MKS, Heran NS, Shemie SD. A review of ancillary tests in evaluating brain death. Can J Neurol Sci 2008; 35: 409-19. 8. Memorial Health University Medical Center. Patient Care Policy: Death Determination-Adult. Savannah, GA: Memorial Health University Medical Center; 2013. 9. Berenguer C, Davis F, Howington J. Brain death confirmation: Comparison of computed tomographic angiography with nuclear medicine perfusion scan. J Trauma 2010; 68: 553-9. 10. Sawicki M, Bohatyrewicz R, Walecka A, Solek-Pastuszka J, Rowinski O, Walecki J. CT angiography in the diagnosis of brain death. Pol J Radiol 2014; 79: 417-21. 11. Wijdicks EF. The diagnosis of brain death. N Engl J Med 2001; 344: 1215-21. 12. Welschehold S, Kerz T, Boor S, Reuland K, Thomke F, Reuland A, et al. Computed tomographic angiography as a useful adjunct in the diagnosis of brain death. J Trauma Acute Care Surg 2013; 74: 1279-85. 13. Escudero D, Otero J, Marques L, Parra D, Gonzalo JA, Albaiceta GM, et al. Diagnosing brain death by CT perfusion and multislice CT angiography. Neurocrit Care 2009; 11: 261-71. 14. Young GB, Shemie SD, Doig CJ, Teitelbaum J. Brief review: the role of ancillary tests in the neurological determination of death. Can J Anaesth 2006; 53: 620-7. 15. Welschehold S, Boor S, Reuland K, Thömke F, Kerz T, Reuland A, et al. Technical aids in the diagnosis of brain death: a comparison of SEP, AEP, EEG, TCD and CT angiography. Dtsch Arztebl Int 2012; 109: 624-30. 16. Machado C, Perez J, Scherle C, Areu A, Pando A. Brain death diagnosis and apnea test safety. Ann Indian Acad Neurol 2009; 12: 197-200. 17. Frampas E, Videcoq M, de Kerviler E, Ricolfi F, Kuoch V, Mourey F, et al. CT angiography for brain death diagnosis. AJNR Am J Neuroradiol 2009; 30: 1566-70. 18. Citerio G, Crippa IA, Bronco A, Vargiolu A, Smith M. Variability in brain death determination in Europe: looking for a solution. Neurocrit Care 2014; 21: 376-82. 19. Welschehold S, Kerz T, Boor S, Reuland K, Thömke F, Reuland A, et al. Detection of intracranial circulatory arrest in brain death using cranial CT-angiography. Eur J Neurol 2013; 20: 173-9. 20. Rappaport ZH, Brinker RA, Rovit RL. Evaluation of brain death by contrast-enhanced computerized cranial tomography. Neurosurgery 1978; 2: 230-2. 21. Rangel RA. Computerized axial tomography in brain death. Stroke 1978; 9: 597-8. 22. Greer DM, Strozyk D, Schwamm LH. False positive CT angiography in brain death. Neurocrit Care 2009; 11: 272-5. 23. Quesnel C, Fulgencio JP, Adrie C, Marro B, Payen L, Lembert N, et al. Limitations of computed tomographic angiography in the diagnosis of brain death. Intensive Care Med 2007; 33: 2129-35. 24. Saritas A, Acar CB, Zinciroglu C, Uzun U, Kose I, Senoglu N. Brain death in intensive care units: problems, differences in methods of diagnosis, and donor care. Exp Clin Transplant 2018; doi: 10.6002/ect.2017.0293. [Epub ahead of print] 25. Alderete JF, Jeri FR, Richardson Jr EP, Sament S, Schwab RS, Young RR. Irreversible coma: a clinical, electroencephalographic and neuropathological study. Trans Am Neurol Assoc 1968; 93: 16-20. 26. Guerit JM. Electroencephalography: the worst traditionally recommended tool for brain death confirmation. Intensive Care Med 2007; 33: 9-10. 27. American Clinical Neurophysiology Society: Guideline 3: minimum technical standards for EEG recording in suspected cerebral death. J Clin Neurophysiol 2006; 23: 97-104. 28. Ducrocq X, Braun M, Debouverie M, Junges C, Hummer M, Vespignani H. Brain death and transcranial Doppler: experience in 130 cases of brain dead patients. J Neurol Sci 1998; 160: 41-6. 29. de Freitas GR, André C. Sensitivity of transcranial Doppler for confirming brain death: a prospective study of 270 cases. Acta Neurol Scand 2006; 113: 426-32. 30. Ding ZY, Zhang Q, Wu JW, Yang ZH, Zhao XQ. A Comparison of Brain Death Criteria between China and the United States. Chin Med J (Engl) 2015; 128: 2896-901.
Abstract
DOI: 10.26650/cjm.2019.43.42
Amaç: Beyin ölümü (BÖ), beyin ve beyin sapı
işlevlerinin kalıcı yokluğunu ifade eder. Doğrulayıcı testler kullanılarak
beyin sapı dışında bile tüm beyin bölgelerinde kan akışı olmadığı
gösterilmelidir. BÖ tanısının uyumsuzluğunu klinik ve yardımcı testler
(bilgisayarlı tomografik anjiyografi (BTA), manyetik rezonans görüntüleme
anjiyografisi (MRIA), transkranial Doppler ultrasonografi (TKD-USG),
elektroensefalografi (EEG)) ile değerlendirmeyi amaçladık.
Yöntemler: 2012-2018 yılları arasında yoğun
bakım ünitemize başvuran hastalar retrospektif olarak değerlendirildi. BÖ için
22 hasta değerlendirildi ve ayrıca 12 tanesinde, BÖ tanısında kesin tanı için
yardımcı testler yapıldı. Tüm hastalar için demografik veriler, BÖ’nün
nedenleri ve takipleri kaydedildi.
Bulgular: On iki hastaya BÖ tanısı kondu.
BÖ’ye neden olan nedenler intrakraniyal kanama, kardiyak arrest, intrakraniyal
tümörler, pulmoner emboli, anevrizmal kanama, menenjit, subaraknoid kanama idi.
Yaş ortalaması 40,86±15,62, ortalama APACHE II skoru 28,23±16,33 idi. Beyin
ölümü 10 hastada klinik olarak teşhis edildi ve 12 hasta yardımcı testlerle
değerlendirildi.
Sonuç: Beyin ölümü klinik kriterlere göre
teşhis edilebilir, ancak bir şekilde doğrulayıcı testler gerekli olabilir.
BÖ’nün klinik olarak tanısı her zaman BTA ile tutarlı değildir ve tekrarlanması
için prosedür gereklidir veya başka ileri teknikler kullanılmalıdır.
Cite this article as: Utku T, Bozbay S,
Ürkmez S, Akçıl EF, Demirkıran O, Dikmen Y. Assessing the consistency of
clinical diagnosis and ancillary tests for brain death. Cerrahpasa Med J 2019;
43(1): 29-33.
References
- 1. The Quality Standards Subcommittee of the American Academy of Neurology. Practice parameters for determining brain death in adults (summary statement). Neurology 1995; 45: 1012-4. 2. Wijdicks EF, Varelas PN, Gronseth GS, Greer DM. Evidence-based guideline update: determining brain death in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2010; 74: 1911-8. 3. Shemie SD, Doig C, Dickens B, Byrne P, Wheelock B, Rocker G, et al. Severe brain injury to neurological determination of death: Canadian forum recommendations. CMAJ 2006; 174: S1-13. 4. Australian and New Zealand Intensive Care Society. The ANZICS Statement on Death and Organ Donation. Edition 3.2. VIC Australia: New Zealand Intensive Care Society; 2013. 5. Academy of Medical Royal Colleges. A code of practice for the diagnosis and confirmation of death. London: Academy of Medical Royal Colleges; 2008. 6. Wijdicks EF. Brain death worldwide: accepted fact but no global consensus in diagnostic criteria. Neurology 2002; 58: 20-5. 7. Heran MKS, Heran NS, Shemie SD. A review of ancillary tests in evaluating brain death. Can J Neurol Sci 2008; 35: 409-19. 8. Memorial Health University Medical Center. Patient Care Policy: Death Determination-Adult. Savannah, GA: Memorial Health University Medical Center; 2013. 9. Berenguer C, Davis F, Howington J. Brain death confirmation: Comparison of computed tomographic angiography with nuclear medicine perfusion scan. J Trauma 2010; 68: 553-9. 10. Sawicki M, Bohatyrewicz R, Walecka A, Solek-Pastuszka J, Rowinski O, Walecki J. CT angiography in the diagnosis of brain death. Pol J Radiol 2014; 79: 417-21. 11. Wijdicks EF. The diagnosis of brain death. N Engl J Med 2001; 344: 1215-21. 12. Welschehold S, Kerz T, Boor S, Reuland K, Thomke F, Reuland A, et al. Computed tomographic angiography as a useful adjunct in the diagnosis of brain death. J Trauma Acute Care Surg 2013; 74: 1279-85. 13. Escudero D, Otero J, Marques L, Parra D, Gonzalo JA, Albaiceta GM, et al. Diagnosing brain death by CT perfusion and multislice CT angiography. Neurocrit Care 2009; 11: 261-71. 14. Young GB, Shemie SD, Doig CJ, Teitelbaum J. Brief review: the role of ancillary tests in the neurological determination of death. Can J Anaesth 2006; 53: 620-7. 15. Welschehold S, Boor S, Reuland K, Thömke F, Kerz T, Reuland A, et al. Technical aids in the diagnosis of brain death: a comparison of SEP, AEP, EEG, TCD and CT angiography. Dtsch Arztebl Int 2012; 109: 624-30. 16. Machado C, Perez J, Scherle C, Areu A, Pando A. Brain death diagnosis and apnea test safety. Ann Indian Acad Neurol 2009; 12: 197-200. 17. Frampas E, Videcoq M, de Kerviler E, Ricolfi F, Kuoch V, Mourey F, et al. CT angiography for brain death diagnosis. AJNR Am J Neuroradiol 2009; 30: 1566-70. 18. Citerio G, Crippa IA, Bronco A, Vargiolu A, Smith M. Variability in brain death determination in Europe: looking for a solution. Neurocrit Care 2014; 21: 376-82. 19. Welschehold S, Kerz T, Boor S, Reuland K, Thömke F, Reuland A, et al. Detection of intracranial circulatory arrest in brain death using cranial CT-angiography. Eur J Neurol 2013; 20: 173-9. 20. Rappaport ZH, Brinker RA, Rovit RL. Evaluation of brain death by contrast-enhanced computerized cranial tomography. Neurosurgery 1978; 2: 230-2. 21. Rangel RA. Computerized axial tomography in brain death. Stroke 1978; 9: 597-8. 22. Greer DM, Strozyk D, Schwamm LH. False positive CT angiography in brain death. Neurocrit Care 2009; 11: 272-5. 23. Quesnel C, Fulgencio JP, Adrie C, Marro B, Payen L, Lembert N, et al. Limitations of computed tomographic angiography in the diagnosis of brain death. Intensive Care Med 2007; 33: 2129-35. 24. Saritas A, Acar CB, Zinciroglu C, Uzun U, Kose I, Senoglu N. Brain death in intensive care units: problems, differences in methods of diagnosis, and donor care. Exp Clin Transplant 2018; doi: 10.6002/ect.2017.0293. [Epub ahead of print] 25. Alderete JF, Jeri FR, Richardson Jr EP, Sament S, Schwab RS, Young RR. Irreversible coma: a clinical, electroencephalographic and neuropathological study. Trans Am Neurol Assoc 1968; 93: 16-20. 26. Guerit JM. Electroencephalography: the worst traditionally recommended tool for brain death confirmation. Intensive Care Med 2007; 33: 9-10. 27. American Clinical Neurophysiology Society: Guideline 3: minimum technical standards for EEG recording in suspected cerebral death. J Clin Neurophysiol 2006; 23: 97-104. 28. Ducrocq X, Braun M, Debouverie M, Junges C, Hummer M, Vespignani H. Brain death and transcranial Doppler: experience in 130 cases of brain dead patients. J Neurol Sci 1998; 160: 41-6. 29. de Freitas GR, André C. Sensitivity of transcranial Doppler for confirming brain death: a prospective study of 270 cases. Acta Neurol Scand 2006; 113: 426-32. 30. Ding ZY, Zhang Q, Wu JW, Yang ZH, Zhao XQ. A Comparison of Brain Death Criteria between China and the United States. Chin Med J (Engl) 2015; 128: 2896-901.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Araştırmalar |
| Authors | |
| Publication Date | July 1, 2019 |
| Published in Issue | Year 2019 Volume: 43 Issue: 1 |
