Importance of EEG as a Confirmatory Test For Brain Death Decision in Aneurysmal SAH Patients

Abstract

Objective: To evaluate the efficacy of electroencephalography (EEG) and cerebral angiography (DSA) as confirmatory tests to diagnose brain death on aneurysmal subarachnoid hemorrhage (aSAH) patients. Material and Method: We prospectively evaluated all aSAH patients who were admitted to Istanbul Medical Faculty Neuro-Intensive Care Unit between June 2010 and June 2011. All patients, who developed brain death according to neurologic evaluation, were evaluated again first with DSA and then EEG as confirmatory tests. Results: Of thirty seven aSAH patients admitted to our ICU during one year period, only 4 were diagnosed with clinical brain death after neurologic evaluation. First, we performed DSA which showed all had minimal cerebral blood flow. Then EEG was performed and only one of them still showed slow wave activity which contradicted brain death but other 3 had isoelectric cerebral silence which supported brain death. These 3 patients died within two days after brain death diagnosis. However, the first patient survived but Glasgow coma score was 3 and transferred to an intermediate care unit for long term care with home type ventilator. Conclusion: Unlike the common argument against confirmatory tests for brain death diagnosis, our study indicated EEG to be more reliable than DSA to confirm brain death in aSAH patients, considering that confirmatory test obligatory for brain death decisions.

Keywords

• Brain death
• confirmatory test
• electroencephalography
• subarachnoid hemorrhage