Hypoxic Ischemic Encephalopathy

November 12, 2012

Hypoxic Ischemic Encephalopathy

Hypoxic ischemic encephalopathy (HIE) refers to temporary or permanent brain damage associated with reduced oxygen or blood supply to the brain. It is a major cause of death and permanent disability in children and adults.


Although the exact cause of hypoxic ischemic encephalopathy is often unknown, brain injury during labor or delivery is possibly the most common underlying factor for the disease. Ruptured uterus, placental bleeding, early separation from placenta, cord accidents or seizures in mothers can also reduce the oxygen supply to the brain of the fetus. Some common causes of HIE in adults include cyanide or carbon monoxide poisoning, drug overdose, strangulation or choking. Clots in the blood vessels leading to the brain can also lower blood and oxygen supply to the brain. Conditions that prevent optimum breathing such as smoke inhalation and respiratory failure as well as diseases that cause paralysis of respiratory organs including myasthenia gravis and Gullain Barre syndrome can lead to HIE. Extreme low blood pressure, especially at high altitudes can increase the risk of hypoxic ischemic encephalopathy.


The type and severity of symptoms associated with hypoxic ischemic encephalopathy depend on the duration of low oxygen supply and the extent of damage caused by it. Mild hypoxic ischemic encephalopathy is characterized by poor focus, judgment and coordination. It may also lead to euphoria or extreme lethargy. The brain cells start dying within five minutes of oxygen deprivation. Thus, a more severe form of HIE can stop brain reflexes such as breathing and response to light. The oxygen deprivation affects the whole brain instead of a specific area, and can cause seizures and coma. Blood pressure and heart function are the only reflexes of brain that work during HIE.


The doctor will perform a quick physical examination and analyze the health history of the patient for a preliminary diagnosis. The diagnosis is further confirmed by tests such as the CT scan and MRI scan, which use x-rays and magnetic waves to take pictures of the brain. The physical dimensions and activities of heart are measured using electrocardiogram, echocardiogram and electroencephalogram. Your doctor may order blood tests to check the blood glucose and oxygen levels. Evoked potential test may be performed to test the functionality of the brain.


Treatment of hypoxic ischemic encephalopathy depends on the underlying cause and the extent of brain damage. Doctors may focus on sustaining heart and brain function, and maintaining the blood pressure. Medications and general anesthesia may be administered to manage seizures. Carbon monoxide poisoning can be treated by supplying significant oxygen to the blood using a hyperbaric oxygen treatment. Brain cooling therapy with the help of a hypothermia system can help treat HIE in newborn babies, especially when administered within 6 hours of birth. This prevents further damage to the brain cells and helps improve brain metabolism.

There is no way to prevent hypoxic ischemic encephalopathy. CPR along with immediate oxygen supply can lower the extent of damage and speed the recovery.


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