In the United States, approximately 1.7 million patients are treated annually for traumatic brain injury, and cerebrovascular insults are the third leading cause of death. Although CT plays a central role in the initial assessment of suspected intracranial injury, planar brain scintigraphy provides valuable information regarding cerebral perfusion, function, and brain death. An understanding of the complexity of injuries is helpful in scintigraphic image interpretation. To illustrate potential scintigraphic confounders, we present 8 suspected brain death cases with correlative CT. Even with negative brain death studies, severe brain injury by CT portends grave outcomes.