“Hot nose” sign in brain death

BACKGROUND: Brain death testing is a rigorous process in which meticulous examination is crucial. In certain cases, ancillary testing is required. CASE DESCRIPTION: A 30-year-old male presented to the emergency room after a motor vehicle accident and was found to have subarachnoid hemorrhage and subdural hematoma. The examination was notable for the absence of brainstem responses. A nuclear medicine brain scan was completed which showed carotid arterial activity up to the level of the skull base with no intracranial arterial activity above with a “hot nose” sign consistent with brain death. CONCLUSION: The “hot nose” sign has been described in brain-dead patients and is postulated to occur due to increased flow to the nose through the external carotid artery.