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‫المستجدات الطبية في موت الدماغ‬

Yasser Mandourah, MD, FRCP(C), FCCP,ABIM
Director, Department of Intensive Care Services (RMH)
Director, Center of Intensive Care Science and Research(RMH)
Vice President Saudi Critical Care Society (SCCS)
Riyadh Armed Forces Hospital
Riyadh, Saudi Arabia
yasser.mandourah@rmh.med.sa
‫المفهوم العلمي لموت الدماغ‬
Intracranial compensation
Concepts of Brain Injury
• Primary injury: area of maximum
  neuronal damage
• Penumbra: area of less injured
  and potentially recoverable
  neuronal tissue
• Secondary injury: follows
  primary injury and causes further
  neuronal damage
Primary Brain Injury
• Trauma: concussion,
  contusion, shear injury
• Ischemia: global, regional
• Inflammation
• Compression: tumor, edema,
  hematoma
• Metabolic insults
Secondary Brain Injury
• Hypoperfusion: high intracranial
  pressure, edema, vasospasm
• Hypoxia: hypoxemia,
  hypoperfusion, high O2
  consumption
• Harmful mediators: reperfusion,
  inflammation
• Electrolyte or acid-base changes
Intracranial pressure volume
Elevated ICP head CT
Pathological A waves (also called
              plateau waves)
•   are abrupt, marked elevations
    in ICP of 50 to 100 mmHg
•    which usually last for minutes
    to hours.
•   The presence of A waves
    signifies a loss of intracranial
    compliance
•    heralds imminent
    decompensation of
    autoregulatory mechanisms
•    the presence of A waves
    should suggest the need for
    urgent intervention to help
    control ICP.
‫آلية تشخيص موت الدماغ‬
              ‫وكيفيته‬
‫النظام المعمول به في المملكة‬
            ‫العربية السعودية‬
‫الفرق بين الحياة النباتية وموت الدماغ.‬
Size is the most important
predictor for patient outcome
                           • A patient with a
                             haemorrhage the
                             size of a ping pong
                   38 ml
                             ball is likely to have
                             a better outcome
                   43 ml
                             than a patient with a
                             haemorrhage the
                             size of golf ball:
                               mortality on ’ping
                                pong’ size: app. 40%
                               mortality on ’golf ball’
                                size: app. 70%
المستجدات الطبية في موت الدماغ للدكتور ياسر مندورة
المستجدات الطبية في موت الدماغ للدكتور ياسر مندورة

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المستجدات الطبية في موت الدماغ للدكتور ياسر مندورة

  • 1. ‫المستجدات الطبية في موت الدماغ‬ Yasser Mandourah, MD, FRCP(C), FCCP,ABIM Director, Department of Intensive Care Services (RMH) Director, Center of Intensive Care Science and Research(RMH) Vice President Saudi Critical Care Society (SCCS) Riyadh Armed Forces Hospital Riyadh, Saudi Arabia yasser.mandourah@rmh.med.sa
  • 4. Concepts of Brain Injury • Primary injury: area of maximum neuronal damage • Penumbra: area of less injured and potentially recoverable neuronal tissue • Secondary injury: follows primary injury and causes further neuronal damage
  • 5. Primary Brain Injury • Trauma: concussion, contusion, shear injury • Ischemia: global, regional • Inflammation • Compression: tumor, edema, hematoma • Metabolic insults
  • 6. Secondary Brain Injury • Hypoperfusion: high intracranial pressure, edema, vasospasm • Hypoxia: hypoxemia, hypoperfusion, high O2 consumption • Harmful mediators: reperfusion, inflammation • Electrolyte or acid-base changes
  • 9.
  • 10. Pathological A waves (also called plateau waves) • are abrupt, marked elevations in ICP of 50 to 100 mmHg • which usually last for minutes to hours. • The presence of A waves signifies a loss of intracranial compliance • heralds imminent decompensation of autoregulatory mechanisms • the presence of A waves should suggest the need for urgent intervention to help control ICP.
  • 11. ‫آلية تشخيص موت الدماغ‬ ‫وكيفيته‬
  • 12.
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  • 20. ‫النظام المعمول به في المملكة‬ ‫العربية السعودية‬
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  • 23. ‫الفرق بين الحياة النباتية وموت الدماغ.‬
  • 24. Size is the most important predictor for patient outcome • A patient with a haemorrhage the size of a ping pong 38 ml ball is likely to have a better outcome 43 ml than a patient with a haemorrhage the size of golf ball:  mortality on ’ping pong’ size: app. 40%  mortality on ’golf ball’ size: app. 70%