The aim of the study was to identify the predictors of brain death (BD) upon 
admission to the intensive care unit (ICU) of comatose patients with spontaneous 
intracerebral hemorrhage (ICH). Patients admitted in our ICU from 2002 to 2010 
for spontaneous ICH and placed under mechanical ventilation were retrospectively 
analyzed. Of the 72 patients, 49% evolved to BD, 39% died after withdrawal of 
life support, and 12% were discharged alive. The most discriminating 
characteristics to predict BD were included in two models; Model 1 contained ≥3 
abolished brainstem responses [adjusted odds ratios (OR) = 8.4 (2.4, 29.1)] and 
the swirl sign on the baseline CT-scan [adjusted OR = 5.0 (1.6, 15.9)] and Model 
2 addressed the abolition of corneal reflexes [unilateral/bilateral: adjusted 
OR = 4.2 (0.9, 20.1)/8.8 (2.4, 32.3)] and the swirl sign on the baseline CT-scan 
[adjusted OR = 6.2 (1.9, 20.0)]. Two scores predicting BD were created 
(sensitivity: 0.89 and 0.88, specificity: 0.68 and 0.65). Risk of evolution 
toward BD was classified as low (corneal reflexes present and no swirl sign), 
high (≥1 corneal reflexes abolished and swirl sign), and intermediate. Simple 
signs at ICU admission can predict BD in comatose patients with ICH and could 
increase the potential for organ donation.