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Hypoxic Ischemic Encephalopathy

Hypoxic Ischemic Encephalopathy. HIE. Brain as 2% of total body mass—consumes 15% of energy generated in the body Brain has no energy stores of its own—depends on the oxygen and glucose from the blood Lack of delivery of oxygen to the brain because of hypotension or respiratory failure

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Hypoxic Ischemic Encephalopathy

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  1. Hypoxic Ischemic Encephalopathy

  2. HIE • Brain as 2% of total body mass—consumes 15% of energy generated in the body • Brain has no energy stores of its own—depends on the oxygen and glucose from the blood • Lack of delivery of oxygen to the brain because of hypotension or respiratory failure • Causes: MI, arrest, shock, asphyxiation, paralysis of respiration, carbon monoxide/cyanide poisoning

  3. Most common cause of energy crisis is a drop of cerebral perfusion (global ischemia) usually resulting from cardiac arrest or shock • Other causes: • Severe sustained hypoglycemia • Generalized seizure • CO poisoning • Hypoxia/ severe anemia

  4. Clinicals • Loss of consciousness within seconds • Permanent cerebral damage occurs after >5 mins hypoxia-ischemia • Better prognosis with intact brainstem function

  5. Poor prognosis if • Absent pupillary light, oculocephalic and oculovestibular reflexes • Absent motor response to pain on Day 3 following injury • >33 ug/L neuron-specific enolase (brain damage) • Bilateral absence of N20 component of somatosensory evoked response (SSEPs)

  6. MetabolicEncephalopathy

  7. Altered mental states due to imbalances, older patients particularly • Hypercarbic encephalopathy • Hypoventilation syndrome • Hepatic encephalopathy • Hyper- hypoglycemia • Hyper- hyponatermia

  8. HypertensiveEncephalopathy

  9. Transient migratory neurologic symptoms associated with the malignant hypertensive state in hypertensive emergency • Reversible with prompt initiation of therapy • Headache, confusion, visual disturbances, seizures, nausea, vomiting, altered mental status (confusion to coma) • May present with symptoms resulting from end-organ damage (cardiovascular symptoms e.g. CHF, angina, dyspnea)

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