Brain Death

A 48-year-old woman was admitted to the emergency department with a history of nuchal rigidity, tonic seizure, and loss of consciousness. Five hours after lumbar puncture for diagnostic purposes, no pupil reaction to light and apnea was detected. Immediate MRI revealed tonsillar impaction in the foramen magnum, loss of signal void in the bilateral internal carotid arteries suggesting arrest in flow, severe gyral swelling, and extensive intravenous thrombi filling vessel lumens (Figure 1). Clinical examinations for brain death were performed on hospital day 20, and were consistent with clinical brain death. On hospital day 22, electroencephalogram was performed, and the result of electrocerebral silence was recorded as being consistent with electroencephalogram criteria for brain death. For determining cerebral blood flow (CBF), conventional angiography or radionuclide angiography was requested by the neurologists. However, the patient's family resolutely refused any additional invasive modality using contrast media or radioactive material. Therefore, on hospital …