Skip to main content
SpringerLink
Log in

Results of four technical investigations in fifty clinically brain dead patients

  • Originals
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Fifty consecutive patients (aged 19–77 years, median 56 years) with primary cerebral diseases and the clinical signs of absent cortical and brainstem function were subjected to electroencephalography (EEG), brainstem acoustic evoked potentials (BAEP), extracranial Doppler ultrasonography (ECD) and arterial digital subtraction angiography (DSA). In the majority of cases the results of the technical tests agreed with the clinical signs and were suggestive of brain death. However, in one patient EEG revealed clear bioelectrical activity. In 6 cases, doubts existed about whether the EEG was isoelectric; in 3 of the 6 cases biological activity might have been present. In 31 of 42 patients ECD showed a typical pattern of intracranial circulatory arrest, in 9 of 42 ECD revealed a pattern suggestive of the cessation of cerebral blood flow. In four patients BAEP recordings compatible with brain death were recorded 2–3 days before intracranial circulatory arrest. In 2 patients with isoelectric EEG and absent BAEP arterial DSA demonstrated residual perfusion. The findings are discussed in view of the conceptional differences concerning brain death. It is concluded that the strict application of the concept of death of the whole brain requires angiographic demonstration of absent intracerebral blood flow.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Al-Din ASN, Jamil AS, Shakir R (1985) Coma and brain stem areflexia in brain stem encephalitis (Fisher's syndrome). Br Med J 291:535–536

    Google Scholar 

  2. Alvarez LA, Lipton RB, Hirschfeld A, Salamon O, Lantos G (1988) Brain death determination by angiography in the setting of a scull defect. Arch Neurol 45:225–227

    Google Scholar 

  3. Bargon G, Arlart I (1985) Die konventionelle Angiographie und die digitale Subtraktionsangiographie (DSA) bei der arteriellen Verschlußkrankheit der extrakraniellen Abschnitte der Zerebralarterien. Röntgen-Blätter 38:33–37

    Google Scholar 

  4. Bennett DR (1978) The EEG in determination of brain death. Ann NY Acad Sci 315:110–119

    Google Scholar 

  5. Biniek R, Ferbert A, Buchner H, Brückmann H (1990) Loss of brainstem acoustic evoked potentials with spontaneous breathing in a patient with supratentorial lesion Eur Neurol 30:38–40

    Google Scholar 

  6. Buchner H, Ferbert A, Brückmann H, Zeumer H, Hacke W (1986) Zur Validität der frühen akustisch evozierten Potentiale in der Diagnose des Hirntodes. Zeitschr EEG-EMG 17:117–122

    Google Scholar 

  7. Buchner H, Schuchardt V (1990) Reliability of electroencephalogram in the diagnosis of brain death. Eur Neurol 30:138–141

    Google Scholar 

  8. Büdingen HJ, von Reutern G-M, Freund H-J (1982) Doppler-Sonographie der extrakraniellen Hirnarterien. Thieme, Stuttgart

    Google Scholar 

  9. Conci F, Procaccio F, Arosio M, Boselli L (1986) Viscero-somatic and viscero-visceral reflexes in brain death. J Neurol Neurosurg Psychiatry 49:695–698

    Google Scholar 

  10. Conference of Royal Colleges and Faculties of the United Kingdom (1976) Diagnosis of brain death. Lancet II:1069–1070

    Google Scholar 

  11. Crüger M, Hagenah R, Hupe W (1976) Bauchhautreflexe und Kremasterreflexe bei traumatogenem Hirntod. Prakt Anästh 11:39–42

    Google Scholar 

  12. Drury I, Westmoreland BF, Sharbrough FW (1987) Fulminant demyelinating polyradiculoneuropathy resembling brain death. Electroencephalogr Clin Neurophysiol 67:42–43

    Google Scholar 

  13. Egol AB, Guntupalli KK (1983) Intravenous infusion device artifact in the EEG-confusion in the diagnosis of electrocerebral silence. Intensive Care Med 9:29–32

    Google Scholar 

  14. Facco E, Caputo P, Casartelli Liviero M, Munari M, Toffoletto F, Fabiani F, Giron G (1988) Auditory and somatosensory evoked potentials in brain-dead patients. Riv Neurol 58:140–145

    Google Scholar 

  15. Frowein RA, Gänshirt H, Richard K-E, Hamel E, Haupt WF (1987) Kriterien des Hirntodes: 3. Generation. Anäsh Intensivther Notfallmed 22:17–20

    Google Scholar 

  16. Galaske RG, Schober O, Heyer R (1988)99mTc-HM-PAO and123I-amphetamine cerebral scintigraphy: a new, non invasive method in determination of brain death in children. Eur J Nucl Med 14:446–452

    Google Scholar 

  17. Guidelines for the determination of death: report of the medical consultants on the diagnosis of death to the President's Commission for the study of Ethical Problems in Medicine and Biomedical and Behavioral Research. J Am Med Assoc 246:2184–2186

  18. Hassler W, Steinmetz H, Pirschel J (1989) Transcranial Doppler study of intracranial circulatory arrest. J Neurosurg 71:195–201

    Google Scholar 

  19. Hughes JR (1978) Limitations of the EEG in coma and brain death. Ann NY Acad Sci 315:121–136

    Google Scholar 

  20. Kaste M, Palo J (1981) Criteria of brain death and removal of cadaveric organs. Ann Clin Res 13:313–317

    Google Scholar 

  21. Kricheff II, Pinto RS, George AE, Braunstein P, Korein J (1978) Angiographic findings in brain death. Ann NY Acad Sci 315:168–183

    Google Scholar 

  22. Lang CJG (1989) EEG activity after brain death? Arch Neurol 46:602

    Google Scholar 

  23. Link J, Wagner W, Rohling R, Mühlberg J (1988) Ist die cerebrale Panangiographie zur Feststellung des Hirntods überflüssig? Anaesthesist 37:43–48

    Google Scholar 

  24. Pallis C (1983) ABC of brain stem death. Br Med J 286:123–124, 209–210, 284–287

    Google Scholar 

  25. Robert F, Mumenthaler M (1977) Kriterien des Hirntodes. Schweiz Med Wochenschr 107:335–341

    Google Scholar 

  26. Ropper AH, Kehne SM, Wechsler L (1987) Transcranial Doppler in brain death. Neurology 37:1733–1735

    Google Scholar 

  27. Schweizerische Akademie der Medizinischen Wissenschaften (1983) Richtlinien für die Definition und die Diagnose des Todes. Bulletin Schweiz Akad Med Wiss 1982–1983, pp 87–101

    Google Scholar 

  28. Stöhr M, Riffel B, Trost E, Baumgärtner H (1987) Akustisch und somatosensibel evozierte Potentiale im Hirntod. Nervenarzt 58:658–664

    Google Scholar 

  29. Swedish Ministry of Health and Social Affairs (1984) The concept of death. Report of the Swedish Committee on Defining Death. Stockholm, Sweden

  30. Takeuchi K, Takeshita H, Takakura K, Shimazone Y, Handa H, Gotoh F, Manaka S, Shiogai T (1987) Evolution of criteria for determination of brain death in Japan. Acta Neurochir (Wien) 87:93–98

    Google Scholar 

  31. Taylor MJ, Houston BD, Lowry NJ (1983) Recovery of auditory brain-stem responses after a severe hypoxic ischemic insult. N Engl J Med 309:1169–1170

    Google Scholar 

  32. Vatne K, Nakstad P, Lunder T (1985) Digital subtraction angiography (DSA) in the evaluation of brain death. Neuroradiology 27:155–157

    Google Scholar 

  33. Walker AE (1977) An appraisal of the criteria of cerebral death. J Am Med Assoc 237:982–986

    Google Scholar 

  34. Wissenschaftlicher Beirat der Bundesärztekammer (1986) Kriterien des Hirntodes. Dtsch Ärztebl 83:2940–2946

    Google Scholar 

  35. Yoneda S, Nishimoto A, Nukada T, Kuriyama Y, Katsurada K, Abe H (1974) To-and-fro movement and external escape of carotid arterial blood in brain death cases. A Doppler ultrasonic study. Stroke 5:707–713

    Google Scholar 

  36. Youngner SJ, Landefeld CS, Coulton CJ, Juknialis BW, Leary M (1989) Brain death and organ retrieval. J Am Med Assoc 261: 2205–2210

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, University of Göttingen, Robert-Koch-Str. 40, W-3400, Göttingen, FRG

    R. Nau,  H. W. Prange & R. Tchorsch

  2. Department of Clinical Neurophysiology, University of Göttingen, FRG

    J. Klingelhöfer, B. Kukowski & D. Sander

  3. Department of Neuroradiology, University of Göttingen, FRG

    K. Rittmeyer

Authors
  1. R. Nau
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. W. Prange
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Klingelhöfer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B. Kukowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. Sander
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R. Tchorsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. K. Rittmeyer
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nau, R., Prange, H.W., Klingelhöfer, J. et al. Results of four technical investigations in fifty clinically brain dead patients. Intensive Care Med 18, 82–88 (1992). https://doi.org/10.1007/BF01705037

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01705037

Key words

Search

Navigation