@article{3099759,
    title = "Comparison between transcranial color Doppler ultrasonography and
angiography in the confirmation of brain death",
    author = "Poularas, J. and Karakitsos, D. and Kouraklis, G. and Kostakis, A. and and De Groot, E. and Kalogeromitros, A. and Bilalis, D. and Boletis, J. and and Karabinis, A.",
    journal = "Transplantation Proceedings",
    year = "2006",
    volume = "38",
    number = "5",
    pages = "1213-1217",
    publisher = "EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC",
    issn = "0041-1345",
    doi = "10.1016/j.transproceed.2006.02.127",
    abstract = "Objective. Cerebral blood flow tests have increasingly been advocated
for the confirmation of brain death (BD). Angiography has been
considered the gold standard in the diagnosis of BD but is invasive. We
validated transcranial color Doppler ultrasonography (TCD) to confirm BD
by comparing it to angiography.
Patients and methods. Forty patients experienced the clinical diagnosis
of brain death due to head injury in 19 cases (47.5%), cerebral
hemorrhage in 11 (27.5%), subarachnoid hemorrhage in 7 (17.5%), and
cerebral infarction in 3 (7.5%). Blood pressure, heart rate, S-PO2, and
P-CO2 were monitored throughout the study. Patients were excluded if
episodes of hypoxia, arrhythmia, and hypotension occurred during
examinations, or if the TCD was not technically feasible.
Results. Both angiography and TCD confirmed BD in all patients. The
agreement between the above methods to confirm BD was 100%. Angiography
showed the absence of filling of intracranial arteries, while TCD
revealed: (1) brief systolic forward flow or systolic spikes and
diastolic reversed flow (50%); (2) brief systolic forward flow or
systolic spikes and no diastolic flow (25%); (3) no demonstrable flow
in a patient in whom flow had been clearly documented on a previous TCD
examination (12.5%). Five patients required repeated TCD examinations,
because of initial detection of a diastolic to-and-fro flow pattern. BD
was confirmed by TCD in the above patients after 30 hours of clinical
BD. Conclusion. TCD was a sensitive tool to diagnose BD, affording a
reliable alternative examination to standard angiography."
}