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NEUROLOGY 1990;40:300
© 1990 American Academy of Neurology

The role of transcranial Doppler in confirming brain death

Sensitivity, specificity, and suggestions for performance and interpretation

G. W. Petty, MD, J. P. Mohr, MD, T. A. Pedley, MD, T. K. Tatemichi, MD, L. Lennihan, MD, D. I. Duterte, MD and R. L. Sacco, MD

Department of Neurology, The Neurological Institute of New York, The College of Physicians and Surgeons of Columbia University, New York, NY.

We performed transcranial Doppler (TCD) examinations on 54 comatose patients over a 1-year period. Of 49 patients with technically adequate TCD examinations, 23 met criteria for determination of brain death by clinical and EEG criteria (21) or clinical criteria alone (2; EEG not performed). A TCD waveform abnormality, consisting of absent or reversed diastolic flow, or small early systolic spikes, in at least 2 intracranial arteries, occurred in 21 brain-dead patients, but in none of the other patients in coma. With appropriate guidelines for performance and interpretation, TCD could be incorporated into institutional protocols as a rapid and convenient alternative to EEG for confirmation of brain death.

Address correspondence and reprint requests to Dr. George W. Petty, Department of Neurology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905.

Supported in part by the Sunny von Bulow Coma and Head Trauma Research Foundation.

Presented in part at the 41st annual meeting of the American Academy of Neurology, Chicago, IL, April 1989.

Received June 16, 1989. Accepted for publication in final form July 7, 1989.




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