This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citing articles on ISI (1)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Radiologic Imaging  • Diagnosis  • Alert me on articles by topic

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Lampl et al¹ correctly state that an inadequate transtemporal window may falsely indicate no blood flow, especially in older women, thus decreasing the sensitivity of transcranial Doppler (TCD) in confirming brain death. They suggest that the routine additional use of the transorbital approach when using TCD to confirm brain death increases the efficacy of the examination.

We believe that routine use of the transorbital approach may be a double-edged sword. We carried out a prospective study of TCD in confirming brain death, in which the flow pattern in the internal carotid artery (ICA) siphon was evaluated in 45 patients. The ICA siphons were insonated using the transorbital approach at a depth of 60 to 70 mm from the surface. The patients were aged 2 to 81 years (mean age, 42.9 ± 19.4 years), and 24 were men. Causes of brain death included head injury (17 patients), subarachnoid hemorrhage (17 patients), . . . [Full Text of this Article]

Gabriel R. de Freitas, MD; Charles André, MD, PhD
Rio de Janeiro, Brazil