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Available online 20 November 2021
Clinico-radiological related to early brain death factors
Factores clínico-radiológicos asociados con muerte encefálica precoz
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D. Escuderoa,
Corresponding author
lolaescudero@telefonica.net

Corresponding author.
, I. Astolaa, S. Balboaa, B. Leoza, Á. Meilanb, C. del Bustoa, B. Quindósa, L. Forcelledoa, D. Vizcainob, L. Martína, E. Salgadoa, L. Viñaa
a Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain
b Sección de Neurorradiología, Servicio de Radiología, Hospital Universitario Central de Asturias, Oviedo, Spain
Received 31 October 2019. Accepted 28 June 2020
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Figures (2)
Tables (3)
Table 1. Diameter of the optic nerve sheath measured in mm.
Table 2. Signs of cerebral herniation and brain swelling on the cranial CT scan.
Table 3. Volume of hematoma, and patient progression in the different studies.
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Abstract
Objective

To identify clinical and radiological factors associated to early evolution to brain death (BD), defined as occurring within the first 24 h.

Design

A retrospective cohort study was made covering the period 2015−2017.

Setting

An adult Intensive Care Unit (ICU).

Patients/methods

Epidemiological, clinical and imaging (CT scan) parameters upon admission to the ICU in patients evolving to BD.

Results

A total of 166 patients with BD (86 males, mean age 62.7 years) were analyzed. Primary cause: intracerebral hemorrhage 42.8%, subarachnoid hemorrhage 18.7%, traumatic brain injury 17.5%, anoxia 9%, stroke 7.8%, other causes 4.2%. Epidemiological data: arterial hypertension 50%, dyslipidemia 34%, smoking 33%, antiplatelet medication 21%, alcoholism 19%, anticoagulant therapy 15%, diabetes 15%. The Glasgow Coma Score (GCS) upon admission was 3 in 68.8% of the cases in early BD versus in 38.2% of the cases in BD occurring after 24 h (p = 0.0001). Eighty-five patients presented supratentorial hematomas with a volume of 90.9 ml in early BD versus 82.7 ml in BD > 24 h (p = 0.54). The mean midline shift was 10.7 mm in early BD versus 7.8 mm in BD > 24 h (p = 0.045). Ninety-one patients presented ventriculomegaly and 38 additionally ependymal transudation (p = 0.021). Thirty-six patients with early BD versus 24 with BD > 24 h presented complete effacement of basal cisterns (p = 0.005), sulcular effacement (p = 0.013), loss of cortico-subcortical differentiation (p = 0.0001) and effacement of the suprasellar cistern (p = 0.005). The optic nerve sheath measurements showed no significant differences between groups.

Conclusions

Early BD (>24 h) was associated to GCS < 5, midline shift, effacement of the basal cisterns, cerebral sulci and suprasellar cistern, and ependymal transudation.

Keywords:
Brain death
Organ donation
Transplantation
Prognostic factors
Severe stroke
Resumen
Objetivo

Identificar los factores clínico-radiológicos que se asocian a evolución precoz a muerte encefálica (ME), definida esta como la ocurrida en ≤24 horas.

Diseño

Estudio de cohortes retrospectivo desde 2015 hasta 2017, ambos incluidos.

Ámbito

Servicio de Medicina Intensiva (SMI) de adultos.

Pacientes y método

Análisis de variables clínico-epidemiológicas y de la TC craneal de ingreso en pacientes con evolución a ME.

Resultados

Se analizaron 166 ME, 86 varones, edad media 62,7 años, 42,8% hemorragia intracerebral, 18,7% HSA, 17,5% TCE, 7,8% ictus isquémico, 9% anoxia y 4,2% otras causas; 50% HTA, 34% dislipemia, 33% tabaquismo, 21% antiagregación, 19% enolismo. El 15% anticoagulación, 15% diabetes. El GCS fue tres en el 68,8% en ME precoz frente 38,2% en ME >24 h (p 0,0001); 85 hematoma supratentorial (90,9 mL en ME precoz vs. 82,7 mL ME tardía, p 0,54); 12 hematoma infratentorial. Desplazamiento medio de línea media 10,7 mm en ME precoz vs. 7,8 mm en ME tardía (p 0,045); 91 pacientes ventriculomegalia y 38 trasudado periependimario (p 0,021). Borramiento completo de cisternas basales 36 en ME precoz frente a 24 en ME tardía (p 0,005), borramiento de surcos (p 0,013), pérdida de diferenciación córtico-subcortical (p 0,0001) y ausencia de cisterna supraselar (p 0,005). La medición de la vaina del nervio óptico no mostró diferencias significativas entre los dos grupos.

Conclusiones

Se asoció con ME ≤ 24 horas el GCS < 5, el desplazamiento de línea media, la pérdida de diferenciación córtico-subcortical, el borramiento de surcos, el borramiento completo de cisternas basales, de la cisterna supraselar y la presencia de trasudado periependimario.

Palabras clave:
Muerte encefálica
Donación de órganos
Trasplantes
Factor pronóstico
Ictus grave

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