Schlake H P, Böttger I G, Grotemeyer K H, Husstedt I W, Brandau W, Schober O
Department of Neurology, University of Münster, FRG.
Intensive Care Med. 1992;18(2):76-81. doi: 10.1007/BF01705036.
A total of 24 patients with clinical evidence of brain death (n = 17), severe coma (n = 2; GCS approximately 3) and apallic syndrome (n = 4) underwent a comparative investigation with 99mTc-HMPAO brain scintigraphy, EEG, auditory and somatosensory evoked potentials. Accompanied by EEG and evoked potentials, brain scintigraphy enabled confirmation of cerebral death in 15/17 patients. In one case clinical examination and evoked potentials suggest brain death, but cerebral perfusion and EEG were normal ("brain stem death"). One patient with evidence of cerebral death in clinical examination, brain scintigraphy and evoked potentials, showed questionable focal EEG activity; however, autopsy revealed intravital autolysis of the entire brain. All patients with apallic syndrome and deep coma showed a distinct cerebral perfusion, but gross EEG abnormalities; evoked potentials were delayed or absent. Planar scintigraphy with 99mTc-HMPAO appears to be superior to neurophysiological techniques discriminating patients with agonal cerebral dysfunction from those with brain death.
共有24例具有脑死亡临床证据的患者（n = 17）、重度昏迷患者（n = 2；格拉斯哥昏迷评分约为3分）和植物状态综合征患者（n = 4）接受了99m锝-六甲基丙二胺肟脑闪烁扫描、脑电图、听觉和体感诱发电位的对比研究。在脑电图和诱发电位的辅助下，脑闪烁扫描能够在17例患者中的15例中确认脑死亡。在1例中，临床检查和诱发电位提示脑死亡，但脑灌注和脑电图正常（“脑干死亡”）。1例在临床检查、脑闪烁扫描和诱发电位中均有脑死亡证据的患者，脑电图显示可疑的局灶性活动；然而，尸检显示全脑生前自溶。所有植物状态综合征和深度昏迷患者均显示明显的脑灌注，但脑电图有明显异常；诱发电位延迟或消失。99m锝-六甲基丙二胺肟平面闪烁扫描在区分濒死期脑功能障碍患者和脑死亡患者方面似乎优于神经生理学技术。
