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Transcranial Doppler in brain death

Transcranial Doppler examinations (TCD) of 24 brain-dead adult patients demonstrated persistent movement of blood within the middle cerebral arteries in 21. The characteristic pattern of Doppler shift frequencies, seen in 14, was a sharply contoured, brief anterograde systolic envelope with reversed diastolic flow. Five others had variants of this pattern, and two had anterograde flow throughout the cardiac cycle, except at the end of diastole. This suggests that the internal carotid and proximal middle cerebral artery circulation remains patent, but distal resistance to flow in the brain is very high in the majority of brain-dead patients. Three other patients with absent brainstem reflexes but persistent EEG activity had normal TCD patterns. The characteristic pattern on TCD may be a useful ancillary finding in the diagnosis of brain death, and normal TCD patterns probably exclude the diagnosis.