case_images: PMC6077554_01
case_images: (a) Cerebral CT scan at H76. Brain tissue shows a loss of differentiation between white matter and gray matter. Lateral ventricles are preserved and Sylvian fissures are visible. (b) Cerebral CT angiography. Bilateral opacification of the internal cerebral veins (arrows) and of the cortical (M4) segment of middle cerebral arteries (circled). The four nonopacification criteria used to confirm brain death are absent. (c) Electroencephalogram. Absence of brain electrical activity, including stimulation, on all derivations confirmed on two 30-minute EEGs done 4 hours apart confirmed brain death. Cardiac electric activity is seen on the EEG (black arrow) synchronized with the actual electrocardiogram (red line). (d) Transcranial Doppler of the right and left middle cerebral arteries. The cerebral blood flow has a normal aspect. There are no signs of intracranial hypertension as diastolic velocities are over 40 cm/s and the Pulsatility Index is above 1.4.
case_images: CRICC2018-2709174.001.jpg
case_images: PMC6077554_01_CRICC2018-2709174.001.jpg
case_images: fig1
case_images: Third and fourth EEG (Figure 1(c)) confirmed brain death. At that time, the TCD patterns remained unchanged (Figure 1(d)). A CT angiography revealed a loss of white matter/gray matter differentiation and a normal 4-point opacification score (Figures 1(a) and 1(b)).