Rapid Brain Death following Cardiac Arrest without Intracranial Pressure Rise and Cerebral Circulation Arrest

Figure 1

(a) Cerebral CT scan at H76. Brain tissue shows a loss of differentiation between white matter and gray matter. Lateral ventricles are preserved and Sylvian fissures are visible. (b) Cerebral CT angiography. Bilateral opacification of the internal cerebral veins (arrows) and of the cortical (M4) segment of middle cerebral arteries (circled). The four nonopacification criteria used to confirm brain death are absent. (c) Electroencephalogram. Absence of brain electrical activity, including stimulation, on all derivations confirmed on two 30-minute EEGs done 4 hours apart confirmed brain death. Cardiac electric activity is seen on the EEG (black arrow) synchronized with the actual electrocardiogram (red line). (d) Transcranial Doppler of the right and left middle cerebral arteries. The cerebral blood flow has a normal aspect. There are no signs of intracranial hypertension as diastolic velocities are over 40 cm/s and the Pulsatility Index is above 1.4.

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