• Hypoxic Ischemic Encephalopathy

    (Cerebral Hypoxia; HIE)

    Definition

    Hypoxic ischemic encephalopathy (HIE) is a condition in which the brain does not receive enough oxygen.
    HIE can be fatal. Brain cells can begin dying within as little as five minutes without oxygen. The disease can also cause long-term damage, including intellectual disability, seizures , and cerebral palsy .
    Blood Supply to the Brain
    IMAGE
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    Causes

    There are a variety of causes of HIE. Any injury and many health conditions can cause a lack of oxygen to the brain. Some common causes are:

    Risk Factors

    Any injury, complication, or condition that causes the brain to have a reduction in blood flow and oxygen is a risk factor for HIE.

    Symptoms

    Symptoms include:
      Mild case:
      • Difficulty paying attention
      • Poor judgment
      • Poor coordination
      • Intense emotions
      • Extreme drowsiness
      Severe oxygen deprivation:
      • Seizures
      • Loss of consciousness
      • Blue-colored skin or lips
      • Difficulty breathing

    Diagnosis

    A physical exam will be done. Typically, the history is the most important factor in making the diagnosis.
    Tests may include the following:

    Treatment

    Treatment depends on the underlying cause of the condition, as well as the severity of the damage to the brain. Treatment options include:
    • Life-sustaining treatment—If brain function has stopped, but damage is not yet extensive, life-sustaining treatment is given.
    • Mechanical ventilation —This may be used if you are unable to breathe without assistance.
    • Treatments for the circulatory system—Treatments are given to maintain heart function and control blood pressure.
    • Seizure control—Medicine and general anesthesia may be given to control seizures.
    • Cooling—Hypoxic brain damage is often caused by heat. Cooling blankets or other means of cooling may be applied to reduce the body's temperature.
    • Hyperbaric oxygen treatment —This treatment is used in cases of carbon monoxide poisoning.

    Prevention

    In most cases, HIE is sudden and cannot be prevented. CPR may be given to prevent significant or long-term brain damage after the oxygen supply has been reduced.

    RESOURCES

    Brain Injury Association of America http://www.biausa.org

    National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca

    Ontario Brain Injury Association http://www.obia.on.ca

    References

    Brain injury secondary to carotid intervention [review]. J Endovasc Ther . 2007;14:219-231.

    Hemphill J, Smith W. Neurologic critical care, including hypoxic-ischemic encephalopathy and subarachnoid hemorrhage. In: Fauci AS, Braunwald E, Kasper DL, et al. Harrison's Principles of Internal Medicine . 17th ed. New York, NY: McGraw-Hill; 2005: chap 269.

    Hypoxic ischemic encephalopathy (HIE). Neurographics website. Available at: http://www.neurographics.org/2/1/1/4.shtml . Accessed February 19, 2013.

    Itoo BA, Al-Hawsawi ZM, Khan AH. Hypoxic ischemic encephalopathy. Incidence and risk factors in North Western Saudi Arabia. Saudi Medical Journal . 2003;24:147-153.

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