This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lövblad, K.-O. Articles by Basssetti, C. Search for Related Content PubMed PubMed Citation Articles by Lövblad, K.-O. Articles by Basssetti, C. Related Collections Acute Cerebral Infarction Brain Circulation and Metabolism Computerized tomography and Magnetic Resonance Imaging

(Stroke. 2000;31:539.)
© 2000 American Heart Association, Inc.

Case Reports

Diffusion-Weighted Magnetic Resonance Imaging in Brain Death

Karl-Olof Lövblad, MD Claudio Basssetti, MD

From the Departments of Neuroradiology (K-O.L.) and Neurology (C.B.), University of Bern (Switzerland).

Correspondence to Karl-Olof Lövblad, MD, Department of Neuroradiology, C212 NRAD IDR, Institute of Diagnostic Radiology, Inselspital, Freiburgstrasse, CH-3010 Bern, Switzerland. E-mail loevk{at}insel.ch

Abstract

Background—Traditionally the diagnosis of brain death is established on the basis of a combination of clinical signs and paraclinical methods. Diffusion-weighted MRI is a new method sensitive to cerebral ischemia. Its value in brain death has not been demonstrated until now.

Case Description—A patient was referred to MRI with suspicion of a brain stem stroke. Echo-planar whole-brain, multislice, diffusion-weighted MRI was performed in addition to conventional sequences and MR angiography sequences. In addition to the extensive bilateral hyperintensities observed on T2-weighted images, diffusion-weighted MRI showed diffuse hyperintensities involving both hemispheres as well as a severe drop in the apparent diffusion coefficient in both affected hemispheres. There was also transtentorial herniation with compression of the brain stem as well as absence of flow voids on the T2-weighted images and absence of intracranial vessels on MR angiography. On the basis of the clinical and imaging findings, it was concluded that the patient was in a state of brain death. The patient died the same day.

Conclusions—With the use of new fast techniques such as diffusion-weighted imaging, now MRI can not only display anatomic changes associated with severe brain suffering but can also demonstrate ultrastructural changes secondary to brain death and differentiate them from edematous changes seen on T2-weighted images.

Key Words: brain death • magnetic resonance imaging • magnetic resonance imaging, diffusion-weighted

This article has been cited by other articles:

				D. M. Greer, P. N. Varelas, S. Haque, and E. F.M. Wijdicks Variability of brain death determination guidelines in leading US neurologic institutions Neurology, January 22, 2008; 70(4): 284 - 289. [Abstract] [Full Text] [PDF]

				F. Marrache, B. Megarbane, S. Pirnay, A. Rhaoui, and M. Thuong Difficulties in assessing brain death in a case of benzodiazepine poisoning with persistent cerebral blood flow Human and Experimental Toxicology, October 1, 2004; 23(10): 503 - 505. [Abstract] [PDF]

				K. Takahashi, R. Matsui, S. Yamagata, and S. Kobayashi Cerebral Infarction Throughout Both Internal Carotid Arteries Detected by Diffusion-Weighted MRI Stroke, March 1, 2001; 32 (3): 817 - 818. [Full Text] [PDF]