0
Correspondence |

Routine Insonation of the Transorbital Window for Confirming Brain Death: a Double-Edged Sword

Gabriel R. de Freitas, MD; Charles André, MD, PhD
Arch Neurol. 2003;60(8):1169. doi:10.1001/archneur.60.8.1169-a.
Text Size: A A A
Published online

Extract

Lampl et al1 correctly state that an inadequate transtemporal window may falsely indicate no blood flow, especially in older women, thus decreasing the sensitivity of transcranial Doppler (TCD) in confirming brain death. They suggest that the routine additional use of the transorbital approach when using TCD to confirm brain death increases the efficacy of the examination.

We believe that routine use of the transorbital approach may be a double-edged sword. We carried out a prospective study of TCD in confirming brain death, in which the flow pattern in the internal carotid artery (ICA) siphon was evaluated in 45 patients. The ICA siphons were insonated using the transorbital approach at a depth of 60 to 70 mm from the surface. The patients were aged 2 to 81 years (mean age, 42.9 ± 19.4 years), and 24 were men. Causes of brain death included head injury (17 patients), subarachnoid hemorrhage (17 patients), intracerebral hemorrhage (4 patients), cerebral infarction (3 patients), anoxic encephalopathy (2 patients), and other (2 patients). In 8 patients (22%), the pattern of flow had a diastolic forward component in the ICA siphon despite blood flow changes compatible with cerebral circulatory arrest in all other intracranial arteries. The final results of our study2 were published after the submission of this letter.

Topics

brain death

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
/>
First page PDF preview

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 2

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
Jobs
brightcove.createExperiences();