IMPORTANT: We currently have a number of bugs related to image cropping and are actively trying to resolve them. In the meantime, we have disabled cropping. Apologies for any inconvenience. Stay informed: radiopaedia.org/chat

Brain death (MRI and CT angiography)

Case contributed by Chris O'Donnell
Diagnosis certain

Presentation

Past history of melanoma resection. Now collapse with status epilepticus. Fixed pupils

Patient Data

Age: 50 years
Gender: Male

Diffuse brain swelling with obliteration of basal cisterns and tonsillar herniation through the foramen magnum but only minor restrcition of diffusion.  The key to this case is the presence of T2 signal in the internal carotid arteries in the carotid canals ie loss of the flow voids.  Recurrence of hemorrhagic melanoma in the anterior brain/genu of the corpus callosum following previous surgical excision.

CTA performed 3 hours post

ct

CTA performed 3 hours post MRI to confirm absent cerebral blood flow.

Diffuse brain swelling (loss of grey/white matter differentiation) with absent intracranial blood flow (despite excellent filling of external carotid arterial branches in the scalp (arrows).

Case Discussion

The absence of blood flow to the brain is the mainstay of the radiological diagnosis of brain death.  This can be demonstrated by CT or MR angiography or radioisotope on nuclear medicine. In this case the loss of internal carotid flow voids on conventional MRI was the clue to brain death.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.