anoxic/hypoxic encephalopathy
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Etiology
- cardiac arrest
- respiratory failure
- catastrophic stroke
- poisoning
- head trauma
Pathology
- hippocampal pyramidal neurons selectively vulnerable[4]
- CA1 region most vulnerable[5]
- cererbellar Purkinje cells selectively vulnerable[4]
- diffusely affects neocortex[2][4]
- thalamus consistently injured[2]
- neurons of the nucleus accumbens relatively spared[3]
- in neonatal anoxia, periventricular white matter is also selectively vulnerable[4]
- calcium channels and excitatory glutamate receptors are implicated in hypoxic/anoxic brain damage[4]
- hypoglycemia & ATP deficiency implicated
Clinical manifestations
- progression through the Glasgow coma scale within seconds to minutes
- 98% of patients with Glasgow coma scale < 5 remain die or remain comatose after 2 weeks
- other signs/symptoms* associated with poor prognosis
- absent corneal reflexes
- absent pupillary reaction to light
- absent withdrawal to pain
- absent motor responses
* 24 hours after onset
Laboratory
- markedly elevated neuron-specific enolase (> 33 ug/L) or serum S-100 associated with poor prognosis
Radiology
- CT or MRI for the evaluation of stroke or head trauma if indicated
- PET scan may play a role in the future
Management
- specific measures for specific etiology
- supportive care for 3-5 days or longer
- induced hypothermia may improve morbidity & mortality if insult is removed
- prognosis
- not immediately apparent
- supportive care for 3-5 days or longer may be needed prior to establishing irreversibility
More general terms
References
- ↑ UpToDate 14.2 http://www.utdol.com
- ↑ 2.0 2.1 2.2 Adams JH et al, The neuropathology of the vegetative state after an acute brain insult. Brain 2000, 123:1327 PMID: https://www.ncbi.nlm.nih.gov/pubmed/10869046
- ↑ 3.0 3.1 Huang KW, Zhao Y Selective sparing of human nucleus accumbens in aging and anoxia. Can J Neurol Sci 1995, 22:290 PMID: https://www.ncbi.nlm.nih.gov/pubmed/8599772
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 Cervos-Navarro J and Deimer NH, Selective vulnerability in brain hypoxia. Crit Rev Neurobiol 1991, 6:149 PMID: https://www.ncbi.nlm.nih.gov/pubmed/1773451
- ↑ 5.0 5.1 Ng T et al, Changes in the hippocampus and the cerbellum resulting from hypoxic insults: frequency and distribution. Acta Neuropathol (Berl) 1989, 78:438 PMID: https://www.ncbi.nlm.nih.gov/pubmed/2782053
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 18, American College of Physicians, Philadelphia 2018
- ↑ Vrselja Z, Daniele SG, Silbereis J at el Restoration of brain circulation and cellular functions hours post-mortem. Nature. volume 568, pages 336-343 (April 17, 2019) PMID: https://www.ncbi.nlm.nih.gov/pubmed/30996318 https://www.nature.com/articles/s41586-019-1099-1
Farahany NA, Greely HT, Giattino GM Part-revived pig brains raise slew of ethical quandaries. Nature. volume 568, (April 17, 2019) PMID: https://www.ncbi.nlm.nih.gov/pubmed/30996311 https://www.nature.com/articles/d41586-019-01168-9
Youngner S, Hyun I Pig experiment challenges assumptions around brain damage in people. Nature. volume 568, (April 17, 2019) PMID: https://www.ncbi.nlm.nih.gov/pubmed/30996309 https://www.nature.com/articles/d41586-019-01169-8