تقديم د. ياسر مندورة عن المستجدات الطبية في موت الدماغ من منظور طبي وشرعي 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

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

2. ‫المفهوم العلمي لموت الدماغ‬

3. Intracranial compensation

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

7. Intracranial pressure volume

8. Elevated ICP head CT

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

20. ‫النظام المعمول به في المملكة‬
‫العربية السعودية‬

23. ‫الفرق بين الحياة النباتية وموت الدماغ.‬

24. Size is the most important
predictor for patient outcome
38 ml
43 ml
• 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%