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We performed transcranial Doppler(TCD)examinations on 54 comatose patients over a 1-year period.Of 49 patients with technically adequate TCD examinations,23 met criteria for determination of brain death by clinical and EEG criteria(21)or clinical criteria alone(2;EEG not performed).A TCD waveform abnormality,consisting of absent or reversed diastolic flow,or small early systolic spikes,in at least 2 intracranial arteries,occurred in 21 brain-dead patients,but in none of the other patients in coma.With appropriate guidelines for performance and interpretation,TCD could be incorporated into institutional protocols as a rapid and convenient alternative to EEG for confirmation of brain death. |
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