Basilar Artery Bifurcation Aneurysm: Rupture of a So-Far Undiagnosed Basilar Artery Bifurcation Aneurysm in an Adolescent, Resulting in Intravital Brain Death; Establishing Brain Death Diagnosis by Imaging

Abstract

A 16-year-old male adolescent complained of a sudden headache with no known cause or trigger, which spontaneously got resolved. Three days later he had another episode of headache and lost consciousness. He was brought to our emergency room, where cardiopulmonary resuscitation was required (Hunt and Hess V). CT showed a massive subarachnoid hemorrhage (SAH) with blood in the basal cisterns (Fisher 4). A CTA failed to opacify the intracranial vasculature, thought to be related to poor timing of the contrast bolus. Thorax CT showed massive aspiration. DSA of the carotid arteries and the left vertebral artery revealed an aneurysm of the basilar artery bifurcation and a standstill of the cerebral circulation beyond the basal arteries. The basilar artery bifurcation aneurysm was considered the most likely cause of the massive SAH. Another DSA examination 30 min later showed the same result. Intravital brain death was diagnosed and documented. After another 2 days of intensive care, the lung, liver, pancreas, heart valves, cornea, and kidneys were harvested and transplanted. The criteria for the diagnosis of intravital brain death are the main topic of this chapter.