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1. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 4, 2008, No. 1 , , ,

sation of brain or brainstem activity or confirming the cerebral circulatory arrest.
sation of brain or brainstem activity or confirming the cerebral circulatory arrest. The neurosonological tests are preferred, allowing bedside evaluation in highly unstable patients, reducing the risk for residual organs function. The evaluation of extraand intracranial cerebral hemodynamic exhibits high resistance pattern parallel with the increase of intracranial pressure, finally leading to cerebral circulatory arrest. Trained personal and strict protocols are required.
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The evaluation of extraand intracranial cerebral hemodynamic exhibits high resistance pattern parallel with the increase of intracranial pressure, finally leading to cerebral circulatory arrest.
sation of brain or brainstem activity or confirming the cerebral circulatory arrest. The neurosonological tests are preferred, allowing bedside evaluation in highly unstable patients, reducing the risk for residual organs function. The evaluation of extraand intracranial cerebral hemodynamic exhibits high resistance pattern parallel with the increase of intracranial pressure, finally leading to cerebral circulatory arrest. Trained personal and strict protocols are required.
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The Neurosonology Research Group (NSRG) of the World Federation of Neurology (WFN) created guidelines for the use of TCD in determination of cerebral circulatory arrest in brain death confirmation [6], and may be adopted and endorsed by national societies [5, 7].
The Neurosonology Research Group (NSRG) of the World Federation of Neurology (WFN) created guidelines for the use of TCD in determination of cerebral circulatory arrest in brain death confirmation [6], and may be adopted and endorsed by national societies [5, 7]. Due to noninvasiveness and bedside evaluation, these tests entered the clinical practice. American Academy of Neurology assessed TCD as a useful adjunct test for the evaluation of cerebral circulatory arrest associated with brain death (Type A, Class II evidence) [8].
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American Academy of Neurology assessed TCD as a useful adjunct test for the evaluation of cerebral circulatory arrest associated with brain death (Type A, Class II evidence) [8].
The Neurosonology Research Group (NSRG) of the World Federation of Neurology (WFN) created guidelines for the use of TCD in determination of cerebral circulatory arrest in brain death confirmation [6], and may be adopted and endorsed by national societies [5, 7]. Due to noninvasiveness and bedside evaluation, these tests entered the clinical practice. American Academy of Neurology assessed TCD as a useful adjunct test for the evaluation of cerebral circulatory arrest associated with brain death (Type A, Class II evidence) [8].
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Due to elasticity of the arterial wall and the compliance of the vasculature distal to the recording site, such cerebral circulatory arrest is associated with Doppler evidence of oscillatory movement of blood in the large arteries at the base of the brain.
Extensive death of brain tissue causes extreme increase of intracranial pressure (ICP). When the ICP equals the diastolic arterial pressure, brain perfusion in present only during systole and with further increase of ICP over the systolic arterial pressure, cerebral perfusion will cease [7]. Due to elasticity of the arterial wall and the compliance of the vasculature distal to the recording site, such cerebral circulatory arrest is associated with Doppler evidence of oscillatory movement of blood in the large arteries at the base of the brain. However the net forward flow volume is zero. With time the oscillations become low amplitude spectral spikes until no pulsations are
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Certain prerequisites must be fulfilled before using Doppler sonography to confirm cerebral circulatory arrest [5, 6, 7].
Certain prerequisites must be fulfilled before using Doppler sonography to confirm cerebral circulatory arrest [5, 6, 7]. The cause of coma must be established and must be sufficient to account for a permanent loss of brain function. Other conditions such as intoxication, hypothermia, severe arterial hypotension, metabolic disorders and others have been excluded. Clinical evaluation by two experienced examiners must show no evidence of cerebral or brainstem functions. Cerebral circulatory arrest can be confirmed if certain extraand intracranial Doppler sonographic findings have been recorded and documented bilaterally on two examinations at an interval of at least 30 min. These findings are systolic spikes or oscillating flow in any cerebral artery which can be recorded by bilateral transcranial insonation for anterior circulation, or any intracranial vertebral or basilar artery which can be recorded by suboccipital insonation for the posterior circulation.
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Cerebral circulatory arrest can be confirmed if certain extraand intracranial Doppler sonographic findings have been recorded and documented bilaterally on two examinations at an interval of at least 30 min.
Certain prerequisites must be fulfilled before using Doppler sonography to confirm cerebral circulatory arrest [5, 6, 7]. The cause of coma must be established and must be sufficient to account for a permanent loss of brain function. Other conditions such as intoxication, hypothermia, severe arterial hypotension, metabolic disorders and others have been excluded. Clinical evaluation by two experienced examiners must show no evidence of cerebral or brainstem functions. Cerebral circulatory arrest can be confirmed if certain extraand intracranial Doppler sonographic findings have been recorded and documented bilaterally on two examinations at an interval of at least 30 min. These findings are systolic spikes or oscillating flow in any cerebral artery which can be recorded by bilateral transcranial insonation for anterior circulation, or any intracranial vertebral or basilar artery which can be recorded by suboccipital insonation for the posterior circulation. The diagnosis established by the intracranial examination must be confirmed by the extracranial bilateral recording of the common carotid arteries, internal carotid arteries and vertebral arteries. Ventricular drains or large openings of the skull like in decompressive craniectomy possibly interfering with the development of the intracranial pressure should not be present. During the examination blood pressure should be monitored, documented, and hypotension should be avoided.
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Sensitivity and specificity for a positive pattern of oscillating flow and systolic spikes, indicating cerebral circulatory arrest were high in selected patient population.
a reliable test that can extend clinical criteria in the assessment of the diagnosis brain death. Sensitivity and specificity for a positive pattern of oscillating flow and systolic spikes, indicating cerebral circulatory arrest were high in selected patient population. Few false-positive cases were reported in the literature, but only two instances [10, 17] were defined as false positive according to predefined criteria in this meta-analysis. In one patient [10] with TCD criteria of cerebral circulatory arrest, weak respiration was recorded after TCD examination. In the other report [17], a clinically brain-dead patient with cerebral circulatory arrest on TCD and angiography, EEG examination became isoelectric only several hours later. Both these patients became brain dead shortly after the false-positive TCD examination. Large opening of the scull may result in false negative results.
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In one patient [10] with TCD criteria of cerebral circulatory arrest, weak respiration was recorded after TCD examination.
a reliable test that can extend clinical criteria in the assessment of the diagnosis brain death. Sensitivity and specificity for a positive pattern of oscillating flow and systolic spikes, indicating cerebral circulatory arrest were high in selected patient population. Few false-positive cases were reported in the literature, but only two instances [10, 17] were defined as false positive according to predefined criteria in this meta-analysis. In one patient [10] with TCD criteria of cerebral circulatory arrest, weak respiration was recorded after TCD examination. In the other report [17], a clinically brain-dead patient with cerebral circulatory arrest on TCD and angiography, EEG examination became isoelectric only several hours later. Both these patients became brain dead shortly after the false-positive TCD examination. Large opening of the scull may result in false negative results. After evaluating validity of TCD diagnosed brain death depending on the time lapse between clinical diagnosis and the performance of TCD, a specificity of 100% 24 hours after the clinical diagnosis was obtained [13].
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In the other report [17], a clinically brain-dead patient with cerebral circulatory arrest on TCD and angiography, EEG examination became isoelectric only several hours later.
a reliable test that can extend clinical criteria in the assessment of the diagnosis brain death. Sensitivity and specificity for a positive pattern of oscillating flow and systolic spikes, indicating cerebral circulatory arrest were high in selected patient population. Few false-positive cases were reported in the literature, but only two instances [10, 17] were defined as false positive according to predefined criteria in this meta-analysis. In one patient [10] with TCD criteria of cerebral circulatory arrest, weak respiration was recorded after TCD examination. In the other report [17], a clinically brain-dead patient with cerebral circulatory arrest on TCD and angiography, EEG examination became isoelectric only several hours later. Both these patients became brain dead shortly after the false-positive TCD examination. Large opening of the scull may result in false negative results. After evaluating validity of TCD diagnosed brain death depending on the time lapse between clinical diagnosis and the performance of TCD, a specificity of 100% 24 hours after the clinical diagnosis was obtained [13].
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Characteristic hemodynamic spectra obtained in insonating arteries by means of TCD according to the protocol may serve as a useful test in cerebral circulatory arrest confirmation.
Characteristic hemodynamic spectra obtained in insonating arteries by means of TCD according to the protocol may serve as a useful test in cerebral circulatory arrest confirmation. It can be applied as a confirmatory test in brain death confirmation only after fulfilling the prerequisites. Clinical evaluation by two experienced examiners must show no evidence of cerebral or brainstem functions, the cause of coma is known and sufficient to account for a permanent loss of brain function and other conditions are excluded.
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Consensus opinion on diagnosis of cerebral circulatory arrest using Doppler sonography.
Ducrocq X, Hassler W, Moritake K, Newell DW, von Reutern GM, Shiograi T, Smith RR. Consensus opinion on diagnosis of cerebral circulatory arrest using Doppler sonography. Task Force Group on cerebral death of the Neurosonology Research Group of the World Federation of Neurology.
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2. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 4, 2008, No. 2 , , ,

brain death, neurosonology, circulatory arrest
brain death, neurosonology, circulatory arrest
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The extracranial and transcranial Doppler sonography confirmed the existence of a cerebral circulatory arrest – systolic spikes or oscillating blood flow were recorded bilaterally from the internal and middle cerebral arteries at an interval of 30 min, while the blood circulation within the external carotid artery was preserved.
Brain CT showed massive cerebral hemorrhage with blood within the ventricle system after rupture of aneurysm of the anterior communicating artery, proved by CT angiography. DSA demonstrated stop of the blood flow at the carotid siphons. The extracranial and transcranial Doppler sonography confirmed the existence of a cerebral circulatory arrest – systolic spikes or oscillating blood flow were recorded bilaterally from the internal and middle cerebral arteries at an interval of 30 min, while the blood circulation within the external carotid artery was preserved.
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Ultrasound monitoring of the cerebral hemodynamics is an easy and informative non-invasive method for evalustion of cerebral circulatory arrest in brain death.
Ultrasound monitoring of the cerebral hemodynamics is an easy and informative non-invasive method for evalustion of cerebral circulatory arrest in brain death.
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Consensus opinion on diagnosis of cerebral circulatory arrest using Doppler sonography.
Ducrocq X, Hassler W, Moritake K, Newell DW, von Reutern GM, Shiograi T, Smith RR. Consensus opinion on diagnosis of cerebral circulatory arrest using Doppler sonography. Task Force Group on cerebral death of the Neurosonology Research Group of the World Federation of Neurology.
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3. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 2, 2012, No. 2 , , ,

Postischemic hyperthermia exacerbates neurologic injury after deep hypothermic circulatory arrest.
Shum T, Nagaschima M, Shinoka T. Postischemic hyperthermia exacerbates neurologic injury after deep hypothermic circulatory arrest.
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4. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 9, 2013, No. 2 , , ,

Unfortunately, after 14 days, the patient developed refractory ICP and circulatory arrest.
values maintained in normal range close to the hemorrhage area (right side), nine days after the hemorrhage. At this time ICP was normal. Unfortunately, after 14 days, the patient developed refractory ICP and circulatory arrest.
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5. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 10, 2014, No. 1 , , ,

; sonography for cerebral circulatory arrest; Computed Tomography; CT angiography; digital subtraction angiography; isotope angiography and isotope scanning of brain [2, 22, 27].
; sonography for cerebral circulatory arrest; Computed Tomography; CT angiography; digital subtraction angiography; isotope angiography and isotope scanning of brain [2, 22, 27]. A reliable prognosis could not be done based on only clinical signs, electrophysiological tests and biomarkers. Cerebral Performance Categories and Glasgow Outcome Scoring System are scales developed for assessment of neurologycal functions after CA, however they are not applicable in the first hours/ days after SCA [22, 27].
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