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Brain death Present status YDS

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Yudh Dev Singh
Yudh Dev Singh

Discusses the present status of Brain Death Concept in Indian Context.

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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]
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
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 : 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 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

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Brain death Present status YDS

  • 1. Dr (Brig) YD Singh MBBS, MD, FIACM, DIT Professor (Internal Medicine) SKN Medical College & Gen Hospital Pune 411 041
  • 2.
  • 3. Normal Brain Anatomy 25 September 2011 Dr (Brig) YD Singh Cerebral Cortex Brain Stem Reticular Activating System Receives multiple sensory inputs & Mediates Consciousness (wakefulness)
  • 4. Two Dimensions of Consciousness 25 September 2011 Dr (Brig) YD Singh
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  • 7.
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  • 16. Causes: Brain Death 25 September 2011 Dr (Brig) YD Singh Normal Cerebral Anoxia
  • 17. Causes: Brain Death 25 September 2011 Dr (Brig) YD Singh Normal Cerebral Haemorrhage
  • 18. Causes: Brain Death 25 September 2011 Dr (Brig) YD Singh Normal Cerebral Trauma
  • 19. 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
  • 20.
  • 21.
  • 22.
  • 23.
  • 24. Brain Death Neurologic Examination 25 September 2011 Dr (Brig) YD Singh Pupils dilated with no constriction to bright light
  • 25.
  • 26. 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
  • 27.
  • 28.
  • 29.
  • 30.
  • 31.
  • 32. Brain Death Confirmatory Testing 25 September 2011 Dr (Brig) YD Singh Electro-Cerebral Silence Normal EEG
  • 33. Brain Death Confirmatory Testing 25 September 2011 Dr (Brig) YD Singh No Intra- Cranial Flow Normal Cerebral Angiography
  • 34. 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
  • 35. Dynamic Nuclear Brain Scan 25 September 2011 Dr (Brig) YD Singh “ Hollow-skull sign” of brain death NEJM 2001;344:1215-1221
  • 36.
  • 37.
  • 38.
  • 39. Persistent Vegetative state 25 September 2011 Dr (Brig) YD Singh Aruna Ramachandra Shanbag Mumbai
  • 40.
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  • 43.
  • 44. Thanks !! 25 September 2011 Dr (Brig) YD Singh