Brain death Present status YDS

Dr (Brig) YD Singh MBBS, MD, FIACM, DIT Professor (Internal Medicine) SKN Medical College & Gen Hospital Pune 411 041

Brain Death ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],25 September 2011 Dr (Brig) YD Singh

Normal Brain Anatomy 25 September 2011 Dr (Brig) YD Singh Cerebral Cortex Brain Stem Reticular Activating System Receives multiple sensory inputs & Mediates Consciousness (wakefulness)

Two Dimensions of Consciousness 25 September 2011 Dr (Brig) YD Singh

Cerebral Cortex: Function 25 September 2011 Dr (Brig) YD Singh ,[object Object],[object Object],[object Object]

Brain Stem : Functions 25 September 2011 Dr (Brig) YD Singh ,[object Object],[object Object],[object Object],[object Object]

Brain Stem : Functions 25 September 2011 Dr (Brig) YD Singh ,[object Object],[object Object],[object Object],[object Object],[object Object]

Death : Definition ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],25 September 2011 Dr (Brig) YD Singh

Brain Death : USA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],25 September 2011 Dr (Brig) YD Singh

Death Definition : Indian Laws ,[object Object],[object Object],[object Object],[object Object],25 September 2011 Dr (Brig) YD Singh

Brain Death : Indian Laws ,[object Object],[object Object],[object Object],25 September 2011 Dr (Brig) YD Singh

Brain Death : India ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],25 September 2011 Dr (Brig) YD Singh

Brain Death : India ,[object Object],[object Object],[object Object],[object Object],[object Object],25 September 2011 Dr (Brig) YD Singh

Causes: Brain Death 25 September 2011 Dr (Brig) YD Singh Normal Cerebral Anoxia

Causes: Brain Death 25 September 2011 Dr (Brig) YD Singh Normal Cerebral Haemorrhage

Causes: Brain Death 25 September 2011 Dr (Brig) YD Singh Normal Cerebral Trauma

Brain Death : Mechanism 25 September 2011 Dr (Brig) YD Singh Neuronal Injury Decreased Intracranial Blood Flow Neuronal Swelling Increased Intracranial Pressure ICP > MAP is incompatible with life

Brain Death: Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],25 September 2011 Dr (Brig) YD Singh

Brain Death: Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],25 September 2011 Dr (Brig) YD Singh

Brain Death Neurologic Examination ,[object Object],[object Object],[object Object],[object Object],[object Object],25 September 2011 Dr (Brig) YD Singh

Brain Death Neurologic Examination ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],25 September 2011 Dr (Brig) YD Singh

Brain Death Neurologic Examination 25 September 2011 Dr (Brig) YD Singh Pupils dilated with no constriction to bright light

Brain Death Neurologic Examination ,[object Object],[object Object],25 September 2011 Dr (Brig) YD Singh

Brain Death Neurologic Examination 25 September 2011 Dr (Brig) YD Singh Occulo-Vestibular Response “ Cold Caloric Testing” Normal Response in Coma No Response in Brain Stem Death

Brain Death Neurologic Examination 25 September 2011 Dr (Brig) YD Singh Facial Sensations & Motor Response ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Brain Death : Apnoea Test ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],25 September 2011 Dr (Brig) YD Singh

Brain Death : Apnoea Test ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],25 September 2011 Dr (Brig) YD Singh

Brain Death Ancillary Confirmatory Testing ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],25 September 2011 Dr (Brig) YD Singh

Brain Death Confirmatory Testing 25 September 2011 Dr (Brig) YD Singh Electro-Cerebral Silence Normal EEG

Brain Death Confirmatory Testing 25 September 2011 Dr (Brig) YD Singh No Intra- Cranial Flow Normal Cerebral Angiography

PET Glucose Metabolism Studies 25 September 2011 Dr (Brig) YD Singh “ Hollow-skull sign” of brain death Cerebral metabolism globally reduced ~50% Normal Nature Rev Neurosci 2005;6:899-909

Dynamic Nuclear Brain Scan 25 September 2011 Dr (Brig) YD Singh “ Hollow-skull sign” of brain death NEJM 2001;344:1215-1221

Conditions Distinct from Brain Death ,[object Object],[object Object],[object Object],25 September 2011 Dr (Brig) YD Singh

Coma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],25 September 2011 Dr (Brig) YD Singh

Persistent Vegetative state ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],25 September 2011 Dr (Brig) YD Singh

Persistent Vegetative state 25 September 2011 Dr (Brig) YD Singh Aruna Ramachandra Shanbag Mumbai

Locked in Syndrome 25 September 2011 Dr (Brig) YD Singh Ventral Pontine Infarct ,[object Object],[object Object],[object Object],[object Object],[object Object]

Brain Death Conclusions ,[object Object],[object Object],[object Object],[object Object],25 September 2011 Dr (Brig) YD Singh

Brain Death Conclusions ,[object Object],[object Object],[object Object],25 September 2011 Dr (Brig) YD Singh

Brain Death : Present Status ,[object Object],[object Object],[object Object],25 September 2011 Dr (Brig) YD Singh

Thanks !! 25 September 2011 Dr (Brig) YD Singh

Brain death Present status YDS

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