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.

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.

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