CT Markers Linked to Brain Death After Acute Brain Injury

TOPLINEEarly CT markers showed reproducible links to progression to death by neurologic criteria (DNC) in patients with nontraumatic acute brain injury, according to a meta-analysis. In post-cardiac arrest cohorts, reduced gray-white matter ratio (GWR) on CT was linked to DNC, and in severe stroke cohorts, CT signs of intracranial mass effect were linked to increased odds of progression to DNC.METHODOLOGYA systematic review and meta-analysis examined the potential predictors of DNC in adults with nontraumatic acute brain injury, including hypoxic-ischemic encephalopathy, intracerebral hemorrhage, ischemic stroke, and infectious or inflammatory diseases.Researchers searched MEDLINE, Embase, Scopus, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials until August 31, 2026, identifying 18 studies totaling 9070 participants.The analysis focused on clinical findings (Glasgow Coma Scale scores, pupillary reflexes), neuroimaging (CT and MRI), neurophysiologic markers (somatosensory evoked potentials), and laboratory biomarkers (neuron-specific enolase).Four studies provided comparable data for quantitative synthesis: two severe stroke cohorts and two post-cardiac arrest cohorts.TAKEAWAYIn severe stroke cohorts, CT markers showing intracranial mass effect (unilateral absence of ambient cistern or herniation) were linked to progression to DNC (pooled odds ratio [OR], 3.14; P < .0001), with no heterogeneity observed between studies.In post-cardiac arrest cohorts, patients progressing to DNC had significantly lower GWR compared with those who did not (pooled mean difference, -0.15; P < .001), with substantial heterogeneity observed between studies.In one post-cardiac arrest cohort, absent pupillary light reflexes and elevated neuron-specific enolase within 6 hours after return of spontaneous circulation were identified as independent predictors of DNC.IN PRACTICE"Within this available literature, CT-based markers appear to show the most reproducible associations with progression to DNC, reflecting diffuse cerebral edema and loss of gray-white matter differentiation after cardiac arrest and severe intracranial mass effect in stroke," the authors wrote, highlighting that evidence in the field remained limited.SOURCEThe study was led by Daniela Schoene, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. It was published online on October 22 in BMC Neurology.LIMITATIONSThe study was hindered by heterogeneous and limited evidence, with few studies suitable for quantitative synthesis. Most studies were retrospective, observational, single-center, and lacking adequate confounder adjustment. Traumatic brain injury was excluded, limiting generalizability, and the 2 pooled stroke cohorts differed by subtype.DISCLOSURESThe study received no specific funding. The authors reported no relevant conflicts of interest.This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.