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Cerebrale schade tgv hypoglycemie

Cerebrale schade tgv hypoglycemie. CAT A. Boreas 20-01-05. Pathofysiologie. Glucose energiesubstraat brein Hypoglycemie: oxidatieve fosforylatie (OF) neemt af  andere energiebronnen zoals lactaat houden OF op gang.

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Cerebrale schade tgv hypoglycemie

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  1. Cerebrale schade tgv hypoglycemie CAT A. Boreas 20-01-05

  2. Pathofysiologie • Glucose energiesubstraat brein • Hypoglycemie: oxidatieve fosforylatie (OF) neemt af andere energiebronnen zoals lactaat houden OF op gang. • Uiteindelijk weefsel alkalose: toename ammoniak, afname lactaat selectieve necrose neuronen.

  3. Neuropathologie I • Necrose neuronen: cerebrale cortex, mn occipitaal, hippocampus, basale ganglia, thalamus, stam, myelum. • Tevens degeneratieve afwijkingen in gliale cellen.

  4. Neuropathologie II • Na verloop van tijd: necrose, calcificaties, atrofie cerebrale cortex, subcorticale en periventriculaire gliose. • Cerebellum relatief gespaard: blijkbaar efficiënter gebruik van glucose.

  5. Beeldvorming • Niet afwijkend of • Lesies basale ganglia, hippocampus, thalamus • Diffuse subcorticale witte stof afwijkingen, mn pariëto-occ. • Atrofie cerebrale cortex

  6. Klinisch • Glucose < 3: afname cognitieve functies • Glucose < 2 mmol/l: toename CBF, vertraging EEG : stupor • Glucose < 1: na verloop van tijd isoelectrisch EEG, uitval, coma  na enkele min necrose neuronen.

  7. Literatuur • Shirayama H, et al. Acute brain injury in hypoglycaemia-induced hemiplegia. Diabet. Med. 2004; 21: 623-624. • Vannucci RC, Vannucci SJ. Hypoglycemic brain injury. Semin Neonatol 2001; 6: 147-155. • Cubo E et al Neuroimaging of hypoglycaemia. Rev Neurol 1998; 26: 774-776.

  8. Literatuur • Traill Z et al. Brain imaging in neonatal hypoglycemia. Arch Dis Child Fetal Neonatal Ed 1998; 79: F145-147. • Powers WJ et al. Effect of stepped hypoglycemia on regional cerebral blood flow response to physiological brain activation. Am J Physiol 1996: 270: H554-559.

  9. Literatuur • Jarjour IT et al. Regional cerebral blood flow during hypoglycaemia in children with IDDM. Diabetologica 1995; 38: 1090-1095. • Auer RN. Hypoglycemic brain damage. Metabol Brain Dis 2004; 19: 169-175.

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