Response to letter from Joffe: “A better title: Limitations of brain death in the interpretation of computed tomographic angiography”

Excerpt

Sir: We thank A.R. Joffe for his comment on our article: “Limitations of computed tomographic angiography in the diagnosis of brain death” [1]. His explanatory remarks on the pathophysiology of brain death may be true; however, the goal of this study was not to redefine the criteria of brain death, but to evaluate the computed tomographic angiography (CT-a) as a confirmatory exam of brain death. Specifically, we did not aim to prove that clinically evaluated brain death was systematically associated with complete and persistent cerebral circulatory arrest. The interpretation of our study, like those of Combes et al. [2] and Leclerc et al. [3], therefore does not seem problematic to us because it refers to the clinical description of brain death as defined by French law and various national guidelines [4, 5]; thus, the sensitivity determined under these standardized conditions appears indisputable to us. Brain death is a perfectly defined clinical situation, contrary to the confirmatory exams. A necessary evaluation of these procedures seems essential to avoid any hasty interpretation which appears to be a source of confusion [6]. Finally, a better knowledge of the semiology of these paraclinical exams (CT-a, EEG, MRI, or radionuclide angiography) could be more effective in clarifying the pathophysiology of brain death, rather than redefining a worldwide well-accepted clinical concept. …