Abstract
Brain death is primarily a clinical diagnosis, but at times when examination cannot be completed or is uncertain, the ancillary tests need to be carried out. Ultrasonography used for detection of cerebral circulatory arrest has an advantage of being non-invasive, inexpensive, complication free and a quick technique. Transcranial Doppler (TCD), cervical colour Doppler and optic nerve sheath diameter are the various modalities which use ultrasound to provide an estimation of cerebral blood flow or intracranial pressure. Out of these TCD is the most reliable and validated technique helpful in the diagnosis of brain death. Certain prerequisites have to be fulfilled before carrying out the examination to decrease the possibility of false-positive and -negative results. The various waveforms seen with progressive increase in ICP are oscillating waveform, short systolic spikes and disappearance of intracranial flow. The other test, cervical colour Doppler, has not been included in the list of standard ancillary tests. However, it is especially of help in patients having absent bone window or when TCD-trained physician is not available. Ultrasonography for optic nerve sheath diameter is a simple, non-invasive, rapid bedside test for diagnosis of raised ICP. A sustained trend of high values points towards cerebral deterioration and possibly brain death if corrective measures fail. But it fails to differentiate BD patients from comatose patients. Thus, out of all TCD is the most sensitive and specific ultrasonographic technique for confirmation of cerebral circulatory arrest. For this reason, it is now increasingly being included as a first-line ancillary test in country-specific guidelines.
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Mahajan, C., Kapoor, I., Prabhakar, H. (2021). Brain Death. In: Robba, C., Citerio, G. (eds) Echography and Doppler of the Brain. Springer, Cham. https://doi.org/10.1007/978-3-030-48202-2_18
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