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21-NOVEMBER-2015 HUDA ABDALLA HAYDARA 45 YEARS
CONDITION AFTER REMOVAL OF THE MENINGIOMA WITH ESCALATING ARTERIAL SPASM LEFT
ICA WITH MASSIVE INFARCTION AND CONNING IN PROGRESSION.
Anamnesis
The patient was operated by me
19-November-2015 for almost radical removal
of the suprasellar meningioma. During MRI
control during surgery, the left ICA showed
massive spasm, for what she was receiving
Nimotop the day before surgery. All measures to
prevent escalation of the spasm were taken. The
clinical picture was with ups and downs, but she
was stable with slight improvement in the
morning of 21-November-2015. The patient was
sent for MRI to evaluate the circulation and it
showed still persisting complete spasm of the
left ICA territory with massive infarction of
the area of involved artery. As the brother of
the patient and the medical staff of the ICU she
was doing will until 21.00 and she was moving
even the right side. At 22.00 I examined her and
the breathing is Chain-Stocks with all data
supporting conning in progression.
The patient was sent to the
operating room and removal of bone flap was
achieved. The patient then was kept in
ventilator to provide maximum protection of the
brain.
The next day morning the
patient showed the clinical picture of brain
stem areflexia, but the brain is pulsating upon
palpation. The patient was in condition
difficult to perform MRI with MRA without
contrast, because she was in the maximum dose of
Dopamine and any interruption showing severe
hypotension. and The microdripper is not
compatible with the MRI.
Comments
One of the criteria of brain death is
stop circulation of the brain. Here for several reasons the
brain still pulsating despite the fact, that the patient has
the full blown clinical picture of brain stem areflexia.
The disappearance of diabetes insipidus,
despite stopping Minirin is an indication for brain death.
It seems that diabetes insipidus as a sign of failure of the
neurohypophysis is manifesting itself in a living person.
For more information about brain death,
please click here!
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