Presentation
Patient presented with an out-of-hospital cardiac arrest, with eventual ROSC after multiple rounds of CPR. Absent brainstem reflexes on examination with potential drug use.
Patient Data
Absent tracer accumulation in the brain with no cerebral perfusion identified. The lack of uptake within the cerebral tissue demonstrates an empty light bulb sign. Increased uptake from the nose demonstrates a hot nose sign.
Case Discussion
Tc-99m labeled hexamethyl propyleneamine oxime (Tc-99m-HMPAO) can be used to measure cerebral blood flow by SPECT to evaluate patients with potential brain death1. HMPAO is bound to white blood cells and provides useful evaluation of absent cerebral blood flow.
In this case, recent use of illicit drugs made exam findings of absent brain stem reflexes equivocal. A SPECT brain perfusion scan was then performed for evaluation of brain death and consideration for potential subsequent organ donation. A brain perfusion study for confirmation of brain death is not a standard scan required for confirmation of brain death: at the institution where this scan was performed, a brain perfusion study is performed on average once every 1-2 years.
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