The use of transcranial Doppler ultrasound in confirming brain death in the setting of skull defects and extraventricular drains.

BACKGROUND: Transcranial Doppler ultrasound (TCD) has been used as a confirmatory test for the diagnosis of brain death (BD), but may be inaccurate in patients with a skull defect or extraventricular drain (EVD).

METHODS AND RESULTS: We report three cases of patients with a skull defect or EVD in whom TCD supported a diagnosis of BD but in which the clinical examination later refuted the diagnosis.

CONCLUSION: We caution against the use of TCD to confirm the diagnosis of BD in the presence of a skull defect or EVD.