LEARN NUCLEAR MEDICINE
Neurology · Case 01
Read the history, inspect the study, then reveal the teaching.
IMAGE PLACEHOLDER · Diagnostic study
Original study · Companion image placeholders
Clinical history
A 36-year-old male presents to the emergency room after being involved in a rollover motor vehicle accident. A nuclear brain death study was performed.
Read the images before opening the teaching panel below.
Brain Death
Imaging Findings
Initial blood flow images studies demonstrate flow within the carotid arteries. However, there is no activity present within the intracranial arteries. Additionally, no activity can be seen in the parenchyma on early or delayed images.
Essential Facts
Planar radionuclide angiograms are a simple and non-invasive way to assess intracerebral brain perfusion.
In the case of cerebral death, activity generally proceeds through the carotid artery to the base of the skull, at which point it stops secondary to increased intracranial pressure which precludes blood flow into the intracranial internal carotid artery. Flow may be seen shunted into the external circulation which can manifest as increased blood flow to the nose “hot nose sign”. The hot nose sign by itself is not diagnostic of brain death.
This is an all or nothing examination, any cerebral or cerebellar activity is not consistent with brain death.
Companion Case
Companion case shows both cerebral and cerebellar blood flow which is inconsistent with brain death.
References
“Central Nervous System.” Essentials of Nuclear Medicine Imaging, by Fred A. Mettler and Milton J. Guiberteau, Elsevier Saunders, 2012, pp. 71–97.