Search results for "brain death"
showing 10 items of 20 documents
Scalp, earlobe and nasopharyngeal recordings of the median nerve somatosensory evoked P14 potential in coma and brain death
1996
Median nerve somatosensory evoked potentials (SEPs) were recorded in a total of 181 patients in coma and brain death. Special attention was paid to derivation of P14 (the positive potential occurring approximately 14 ms after median nerve stimulation) with different electrode montages, using midfrontal scalp (Fz), linked earlobe (A1/2), median nasopharyngeal (Pgz) and non-cephalic reference (NC) electrodes. The P14 amplitude (and, to a lesser extent, latency) were invariably lower in brain death than in coma. The potential was preserved in coma in all patients, but lost in brain death in 9.8% in Fz-NC and Pgz-NC recordings, in 23.2% in Fz-A1/2, and in 100% in Fz-Pgz. Thus, Fz-Pgz was the de…
Tc-99m HMPAO Cerebral Scintigraphy A Reliable, Noninvaslve Method for Determination of Brain Death
1993
To determine the usefulness of cerebral blood flow imaging for the diagnosis of brain death, 4 female and 12 male patients, aged 19 to 69 years and suffering from various intracranial lesions, were studied. In addition to neurologic examination, electroencephalographic recording, and cerebral angiography, tomographic brain scintigraphy was performed using a SPECT system with a LEAP collimator after the intravenous administration of 555 MBq Tc-99m HMPAO. The radioisotopic scanning procedure revealed no intracranial perfusion in 14 of the 16 patients. Only minimal cerebellar blood flow was seen in one patient. In another, residual right-sided supratentorial flow was initially present but abse…
Contrast-enhanced transcranial Doppler ultrasonography in the diagnosis of brain death
2013
The diagnosis of brain death (BD) is based on clinical criteria including deep coma, brain stem areflexia and apnoea. Depending on different local guidelines, confirmatory technical tests are sometimes mandatory.1 Since the 1990s, transcranial Doppler sonography (TCD) has found its place in these circumstances and fulfils most of the criteria of an ‘ideal test’ in confirming BD. To confirm intracranial circulatory arrest (CA) with Doppler sonography, typical flow patterns must be recorded in bilateral intracranial and extracranial brain-supplying arteries.2 A completely absent intracranial flow signal is not a reliable sign to determine CA because this can be due to transmission problems. I…
Cerebral potentials elicited by mechanical stimuli to the human leg: influence of artifacts
1992
Mechanical stimulation with a reflex hammer was applied to the quadriceps muscle tendon of healthy volunteers and patients. The time-locked electrical signals were recorded from the scalp. In all cases, reproducible potentials could be recorded, with latencies in a range of 20 ms to 100 ms. The potentials recorded in patients under complete spinal anesthesia were similar to those derived before the anesthesia. In brain dead patients who showed absence of median nerve or posterior tibial nerve SEP, reproducible potentials after mechanical stimuli could be recorded as well. The results suggest that the hammer taps lead to mechanical shock waves which are propagated along the body producing ti…
Long-term outcome after living donor liver transplantation compared to donation after brain death in autoimmune liver diseases: Experience from the E…
2021
Knowledge of living donor liver transplantation (LDLT) for autoimmune liver diseases (AILDs) is scarce. This study analyzed survival in LDLT recipients registered in the European Liver Transplant Registry with autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis (PSC) and the non-autoimmune disorder alcohol-related cirrhosis. In total, 29 902 individuals enrolled between 1998 and 2017 were analyzed, including 1003 with LDLT. Survival from >90 days after LDLT for AILDs in adults was 85.5%, 74.2%, and 58.0% after 5, 10, and 15 years. Adjusted for recipient age, sex, and liver transplantation era, adult PSC patients receiving LDLT showed increased mortality compare…
Detection of intracranial circulatory arrest in brain death using cranial CT-angiography.
2011
Background and purpose Computed tomographic-angiography (CT-A) is becoming more accepted in detecting intracranial circulatory arrest in brain death (BD). An international consensus about the use and the parameters of this technique is currently not established. We examined intracranial contrast enhancement in CT-A after clinically confirmed BD, compared the results with electroencephalography (EEG) and Transcranial Doppler Ultrasonography (TCD) findings and developed a commonly applicable CT-A protocol. Methods Prospective, monocentric study between April 2008 and October 2011. EEG, TCD and CT-A were performed in 63 patients aged between 18 and 88 years (mean, 55 years) who fulfilled clini…
Transcranial Doppler ultrasonography in the assessment of cerebral circulation arrest: improving sensitivity by trancervical and transorbital carotid…
2009
INTRODUCTION: Transcranial Doppler (TCD) can detect the cerebral circulation arrest (CCA) in brain death. TCD is highly specific, but less sensitive because of false-negatives accounting for up to 10%. The aim of the study was to explore the diagnostic accuracy of TCD and to determine whether it can be augmented by strategies such as the insonation of the extracranial internal carotid artery (ICA) and sequential examinations. METHODS: Data of 184 patients, who met clinical criteria of brain death, observed from 1998 through 2006, were retrospectively reviewed. The study of cerebral arteries was performed through the transtemporal approach, suboccipital insonation of the vertebro-basilar sys…
Transcranial doppler and near infrared spectroscopy in the perioperative period
2013
Maintenance of adequate blood flow and oxygen to the brain is one of the principal endpoints of all surgery and anesthesia. During operations in general anesthesia, however, the brain is at particular risk for silent ischemia. Despite this risk, the brain still remains one of the last monitored organs in clincial anesthesiology.Transcranial Doppler (TCD) sonography and near-infrared spectroscopy (NIRS) experience a revival as these noninvasive technologies help to detect silent cerebral ischemia. TCD allows for quantification of blood flow velocities in basal intracranial arteries. TCD-derived variables such as the pulsatility index might hint toward diminished cognitive reserve or raised i…
Determination of Brain Death/Death by Neurologic Criteria
2020
Importance: There are inconsistencies in concept, criteria, practice, and documentation of brain death/death by neurologic criteria (BD/DNC) both internationally and within countries. Objective: To formulate a consensus statement of recommendations on determination of BD/DNC based on review of the literature and expert opinion of a large multidisciplinary, international panel. Process: Relevant international professional societies were recruited to develop recommendations regarding determination of BD/DNC. Literature searches of the Cochrane, Embase, and MEDLINE databases included January 1, 1992, through April 2020 identified pertinent articles for review. Because of the lack of high-quali…
Invitation to participate in a multi-center study for validation of cerebral computed tomography angiography and computed tomography perfusion in the…
2021
In recent years commensal microorganisms are not just “passive occupants”, but important element of homeostasis. There are numerous reports documenting the composition and role of the gut, skin or vagina microbiome but the role of commensal organisms living in the lungs is relatively unknown. Pulmonary microbiome impact on the immune response of the host organism and may indicate new therapeutic directions. Lung microbiome, by modulating the expression of innate immunity genes, causes an increase in the concentration of IL-5, IL-10, IFNγ and CCL11, affects the TLR4 dependent response of pulmonary macrophages and modulate the production of antibacterial peptides contained in the mucus. It is…