المستجدات الطبية في موت الدماغ للدكتور ياسر مندورة

المستجدات الطبية في موت الدماغ

Yasser Mandourah, MD, FRCP(C), FCCP,ABIMDirector, 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 HospitalRiyadh, Saudi Arabiayasser.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: followsprimary 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 ball is likely to have a better outcome 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%

38 ml

43 ml