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November 6, 2002

Radiologic Diagnosis of Brain Death

JAMA. 2002;288(17):2121-2122. doi:10.1001/jama.288.17.2118

To the Editor: The diagnosis of brain death relies on clinical documentation that the patient is in a coma, has no brain stem reflexes, and is apneic following maximal stimulation of respiratory centers. The American Academy of Neurology calls for at least a 6-hour observation period before a second clinical examination that is consistent with brain death can be used to confirm the diagnosis.1 It may be difficult and time consuming to make an official diagnosis of brain death, however, especially when variables such as sedative drugs, hypothermia, or acute metabolic derangements complicate the patient's status. Therefore the diagnosis is often supported by confirmatory tests including radionuclide brain perfusion imaging, cerebral angiography, electroencephalography, or transcranial doppler.