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Radionuclide cerebral perfusion scintigraphy in determination of brain death in children

Departments of Pediatrics (Drs. Holzman and Montes), Neurology (Drs. Curless and Ajmone-Marsan), and Radiology (Dr. Sfakianakis), University of Miami School of Medicine, Miami, FL.

We evaluated a radionuclide scintigraphic technique for imaging relative cerebral perfusion in 18 children who had no evidence of cortical and brainstem function. Patients without scintigraphic evidence of cerebral perfusion all later met criteria for diagnosis of brain death. Patients who failed to satisfy brain-death criteria had persistent scintigraphic evidence of cerebral perfusion. Seven patients with normal scintigraphic studies were being treated with barbiturates and hypothermia at levels that attenuated or completely suppressed EEG activity. Four patients without scintigraphic evidence of' cerebral perfusion had mean arterial pressures (MAP) higher than (54.8 ± 7.6 torr) intracranial pressures (ICP) at the time of scintigraphic study, suggesting that ICP in excess of MAP is not the sole explanation for the absence of cerebral perfusion. Radionuclide cerebral perfusion scintigraphy (RCPS) is a rapid, portable, accurate test that appears to be useful in the diagnosis of brain death in the pediatric population.

Address correspondence and reprint requests to Dr. Holzman, Division of Pediatric Critical Care Medicine, University of Miami School of Medicine, PO Box 016960 (R-131). Miami, FL 33101.

Presented in part at the thirty-third annual meeting of the American Academy of Neurology, Toronto, Canada, May 2, 1982.

Accepted for publication December 8, 1982.

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