In the Czech Republic, brain death can be pronounced after two panangiography series done with 30 minutes time interval in-between. This examination has a high falsely negative results, even though the patient is apparently brain dead, according to the clinical examination. Radio-opaque fluid frequently flows above skull base to the intracranial part of the vasculature; sometimes, ophthalmic artery can be visualized. The intracranial filling of the vasculature can be affected by previous decompressive craniectomy. Based on the authors’ experience, there are recommended possible changes in the evaluation of brain death. This should be stated on clinical examination and single panangiography. The perfusion in the vertebral arteries should be limited to the extracranial part only. In the carotid arteries, perfusion should be allowed also for ophthalmic artery, but not to the Willis circle arteries and branches.

        Key words: brain panangiography – clinical examination