Burger R, Schlake H P, Seybold S, Reiners C, Bendszus M, Roosen K
Neurochirurgische Klinik, Universität Würzburg.
Zentralbl Neurochir. 2000;61(1):7-13. doi: 10.1055/s-2000-8259.
Since 1991 transcranial doppler sonography has been accepted in Germany as a technical confirmatory test for the assessment of a cerebral circulatory arrest in patients fulfilling the clinical criteria of brain death. This study correlated transcranial doppler findings to established scintigraphic methods such as planar scintigraphy, 99mTc-HMPAO SPECT and EEG patterns. 21 patients (15 males/6 females, mean age 15-69 yrs.) fulfilled all clinical criteria of brain death. They suffered from head injuries and spontaneous bleedings. All clinical and technical investigations were performed within 60-90 minutes. In 14/21 patients clinical findings and all confirmatory tests were consistent with brain death. Planar scintigraphy and SPECT gave completely corresponding results in all 21 patients. 7 patients showed not corresponding results. In two head-injured patients with skull defects TCD yielded an oscillating flow in the MCA but SPECT/planar scintigraphy gave a residual perfusion in the related brain areas. A corresponding residual EEG pattern was seen in one case. A patient with osteoclastic skull defect showed a collateral flow from the external carotid artery and another case a secondary reperfusion in depth of a regular expected MCA signal 12 hours after definitely verification of systolic spikes in the Circle of Willis. No cerebral perfusion was detectable in the scintigraphique techniques. In the three remainder with rest activity in EEG, TCD and radionuclide methods showed no intracranial perfusion. In the presence of open skull fractures, external liquor drainages and osteoclastic craniotomies oscillating flow in TCD does not constantly represent a cerebral circulatory arrest. Awaiting of systolic spikes is absolutely necessary, if no radionuclide method is available. Determination of brain death by TCD should be carried out by an experienced investigator since unexpected collateral flow signals can be misinterpreted.
自1991年以来，经颅多普勒超声检查在德国已被接受为一项技术验证性检查，用于评估符合脑死亡临床标准患者的脑循环骤停情况。本研究将经颅多普勒检查结果与已确立的闪烁显像方法（如平面闪烁显像、99mTc-HMPAO单光子发射计算机断层扫描和脑电图模式）进行了关联。21例患者（15例男性/6例女性，平均年龄15 - 69岁）符合脑死亡的所有临床标准。他们因头部受伤和自发性出血入院。所有临床和技术检查均在60 - 90分钟内完成。21例患者中有14例的临床检查结果和所有验证性检查均与脑死亡相符。平面闪烁显像和单光子发射计算机断层扫描在所有21例患者中给出了完全一致的结果。7例患者的检查结果不相符。在2例有颅骨缺损的头部受伤患者中，经颅多普勒检查显示大脑中动脉有振荡血流，但单光子发射计算机断层扫描/平面闪烁显像显示相关脑区有残余灌注。其中1例出现了相应的残余脑电图模式。1例患有破骨性颅骨缺损的患者显示有来自颈外动脉的侧支血流，另1例在明确证实 Willis 环出现收缩期尖峰信号12小时后，大脑中动脉出现了预期的继发性深部再灌注。闪烁显像技术未检测到脑灌注。其余3例脑电图有静息活动的患者，经颅多普勒检查和放射性核素方法均未显示颅内灌注。在存在开放性颅骨骨折、外部脑脊液引流和破骨性开颅手术的情况下，经颅多普勒检查中的振荡血流并不一定代表脑循环骤停。如果没有放射性核素方法，绝对有必要等待收缩期尖峰信号出现。经颅多普勒检查判定脑死亡应由经验丰富的检查者进行，因为意外的侧支血流信号可能会被误判。
