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Transcranial Doppler ultrasonography (TCD) is a valuable tool for demonstrating cerebral circulatory arrest (CCA) in the setting of brain death. Complete reversal of diastolic flow (to-and-fro flow) and systolic spikes in bilateral terminal internal carotid arteries and vertebrobasilar circulation are considered as specific sonogram configurations supporting the diagnosis of CCA. Because of the possibility of sonic bone window impermeability, absence of any waveform in TCD is not confirmatory for CCA unless there is documentation of disappearance of a previously well detected signal by the same recording settings. Transcranial color-coded sonography (TCCS) with B-mode imaging can reliably detect adequacy of bone windows with clarity contralateral skull and ipsilateral planum temporale visualization. Therefore, absence of detectable intracranial Doppler signal along with available ultrasound window in TCCS can confirm clinical diagnosis of brain death. We herein discuss this entity from the frame of a representative case

Absence of Doppler signal in transcranial color-coded ultrasonography may be confirmatory for brain death: A case report