Figure 1: Evolution from normal to positive study.

34-year-old female s/p MVA

A. Initial study utilizing Tc-99m ECD demonstrates flow in the distribution of the bilateral anterior and middle cerebral arteries. Static immediate and delayed images demonstrate normal brain metabolism. Note the intracranial pressure monitor in place (arrow).

B. Twenty-four hours later persistent but diminished flow and metabolism are noted, left greater than right. Venous flow is identified (arrow).

C. The following day, absent perfusion and metabolism are identified, compatible with the clinical diagnosis of brain death. Shunting of blood to the face and scalp via the external carotid arteries are noted.

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