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Diagnosing Brain Death Using the Transcranial Doppler With a Transorbital Approach
Yair Lampl, MD;
Ronit Gilad, MD;
Yehiel Eschel, MD;
Mona Boaz, PhD;
Abraham Rapoport, MD;
Menachem Sadeh, MD
Arch Neurol. 2002;59:58-60.
Background Transcranial Doppler is a sensitive instrument for the diagnosis of
brain death. The guidelines for the determination of brain death include the
demonstration of specific blood flow patterns in the anterior and posterior
circulation systems. A limitation of this method is the frequent false finding
of no flow, especially when using the transtemporal approach in older women.
Objective To evaluate the efficacy of the transorbital approach in the diagnosis
of brain death using transcranial Doppler.
Methods A prospective controlled, diagnostic test study was performed. Transorbital,
transtemporal, and transforaminal approaches were used. Fifty-seven patients
(29 men and 28 women; mean ± SD age, 68.2 ± 12.1 years) with
clinically determined brain death were examined.
Results In 45 patients, oscillatory flow or systolic spikes were found in all
approaches. In 4 patients, no flow was detected. In 6 patients, oscillatory
flow or systolic spikes were found in 2 approaches, including the transorbital
one. In 2 patients, a positive finding was demonstrated only using the transorbital
approach. Using the transorbital approach, the percentage of positive findings
with definitive diagnoses of brain death rose from 79% to 88%.
Conclusion The transorbital approach is a useful addition for the diagnosis of
brain death, using the transcranial Doppler technique.
From the Department of Neurology (Drs Lampl, Gilad, Eschel, Rapoport,
and Sadeh) and Human Biostatistics Institute (Dr Boaz), The E. Wolfson Medical
Center, Holon (Drs Lampl, Gilad, Eschel, Boaz, Rapoport, and Sadeh), and Sackler
Faculty of Medicine, Tel Aviv University, Tel Aviv (Drs Lampl, Gilad, Eschel,
Rapoport, and Sadeh), Israel.
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