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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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Presentation Transcript
pathofysiologie
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.
neuropathologie i
Neuropathologie I
  • Necrose neuronen: cerebrale cortex, mn occipitaal, hippocampus, basale ganglia, thalamus, stam, myelum.
  • Tevens degeneratieve afwijkingen in gliale cellen.
neuropathologie ii
Neuropathologie II
  • Na verloop van tijd: necrose, calcificaties, atrofie cerebrale cortex, subcorticale en periventriculaire gliose.
  • Cerebellum relatief gespaard: blijkbaar efficiënter gebruik van glucose.
beeldvorming
Beeldvorming
  • Niet afwijkend of
  • Lesies basale ganglia, hippocampus, thalamus
  • Diffuse subcorticale witte stof afwijkingen, mn pariëto-occ.
  • Atrofie cerebrale cortex
klinisch
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.
literatuur
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.
literatuur8
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.
literatuur9
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.