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Hypoxic-Ischemic Brain Injury

HIE


Presentation

  • The clinical presentation and course of the case described here have not previously been reported for this extremely rare condition.[ncbi.nlm.nih.gov]
  • Nulliparity, previous cesarean delivery, short stature, overweight, gestational age, occiput posterior presentation and birthweight were all independently associated with hypoxic ischemic encephalopathy.[ncbi.nlm.nih.gov]
  • The aim of the present paper is to review present knowledge about the pathophysiology of perinatal hypoxic-ischemic encephalopathy, especially with respect to novel treatment strategies and biomarkers that might enhance early detection of this disorder[ncbi.nlm.nih.gov]
  • We report a case of IRM presenting with hypoxic ischemic encephalopathy (HIE). There were no prenatal complications caused by fetal brain injury.[ncbi.nlm.nih.gov]
  • In addition, in two infants, MR images showed cysts not present on sonograms.[ncbi.nlm.nih.gov]
Increased Energy
  • Measurement of energy needs is prudent when weight loss is unexplained or increased energy expenditure is suspected.[ncbi.nlm.nih.gov]
Normal Hearing
  • RESULTS: SEP to median nerve stimulation showed bilateral absence of the N20 component, while the N13 and P14 peaks were preserved; BAEP showed normal I-V interpeak latency and normal hearing threshold.[ncbi.nlm.nih.gov]
Decrease in Height
  • The risk of hypoxic ischemic encephalopathy increased with decreasing maternal height and increasing body mass index.[ncbi.nlm.nih.gov]
Waardenburg Syndrome
  • We describe a male infant with a novel SOX10 mutation and a severe course of PCWH--a special phenotype of Shah-Waardenburg syndrome involving peripheral demyelinating neuropathy, central dysmyelinating leukodystrophy, Waardenburg syndrome, and Hirschsprung's[ncbi.nlm.nih.gov]

Workup

  • All neonates with stroke had a negative thrombophilia workup. Neonates with stroke had a significantly higher incidence of seizures and increased initial platelet counts on univariate analysis.[ncbi.nlm.nih.gov]
  • Cerebral Palsy Workup: Approach Considerations, Potentially Helpful Laboratory Tests, Cranial Imaging Studies. (2018, October 02). Retrieved from .[hiehelpcenter.org]
  • Electroencephalography (EEG) - Standard and amplitude-integrated EEG Hearing test - An increased incidence of deafness has been found among infants with hypoxic-ischemic encephalopathy who require assisted ventilation Retinal and ophthalmic examination See Workup[emedicine.medscape.com]
  • These guidelines did not address evidence needed for diagnosis of seizures, but were confined to suggestions as to which ASDs were to be considered as 1st-, 2nd- and 3rd-line treatments for seizures, and provided a suggested workup for the potential causes[karger.com]
  • The SBU assessment stated: "[t]here is limited evidence that either visually rated EEG or qEEG helps the diagnostic workup differentiate AD (Alzheimer’s Disease) patients from controls or AD from other dementia disorders."[aetna.com]
Burst Suppression
  • Abstract In the prediction of neurological sequelae after hypoxic-ischemic encephalopathy (HIE) in the newborn, the electroencephalogram (EEG) burst suppression pattern (BS) and subcortical leukomalacia can mean grave neurodevelopmental problems will[ncbi.nlm.nih.gov]
  • Odds ratios for predicting moderate-severe MRI injury for TEP 2 , TEP 2 , burst Suppression or worse aEEG pattern were 55 (confidence interval (CI) 6.4 to 471), 12.5 (CI 3.8 to 40.7) and 6.7 (CI 2.0 to 19.8), respectively.[ncbi.nlm.nih.gov]
  • Predictors included pH 6.8 on day of birth (adjusted odds ratio [OR] 19 [95% confidence interval (CI) 1-371]), burst suppression on EEG on day 4 (8.2 [1.3-59]), and MRI deep gray matter injury (OR 33 [2.4-460]).[ncbi.nlm.nih.gov]
  • Many prognostications are based on particular EEG patterns at a time point, such as burst suppression or generalized periodic discharges, but with sequential, repeated, or with prolonged or continuous EEG monitoring, it has become increasingly clear that[ncbi.nlm.nih.gov]
  • Literature Review The burst suppression (BS) pattern of the EEG was originally described as a response to large dosages of anesthetics and sedatives.[researchgate.net]
Periodic Lateralized Epileptiform Discharges
  • It is the purpose of this review to critically consider and organize the literature dealing with the ephemeral electroencephalographic (EEG) pattern periodic lateralized epileptiform discharges (PLEDs).[researchgate.net]
  • lateralized epileptiform discharges and saw gray matter lesions only, and metabolic or electrophysiologic etiologies were also implicated in GPDs. 30, 31 These findings suggest a role for the coordination of cortical and subcortical/brain stem structures[ajnr.org]
  • In addition to the presence or absence of reactivity and spontaneous fluctuations the EEGs also were specifically assessed for characteristic patterns such as periodic lateralized epileptiform discharges (PLEDs), bilateral PLEDs (BiPLEDs), periodic generalized[academic.oup.com]

Treatment

  • Patients in the observation group underwent conventional treatment combined with neuroprotective therapeutic strategies. The effects of the different treatment strategies were compared.[ncbi.nlm.nih.gov]
  • Further research is needed to better understand if the long-term impact of the experimental treatments and whether the combinations of experimental treatments can improve outcomes in infants with HIE.[ncbi.nlm.nih.gov]
  • Although the cylinder and rotarod tests showed a trend of amelioration of behavioral impairments from the treatment, these were not statistically significant. Morphological brain injuries were not altered by treatment.[ncbi.nlm.nih.gov]
  • Randomized controlled trials comparing monosialoganglioside with the usual treatment for newborns having HIE deemed eligible.[ncbi.nlm.nih.gov]
  • We aimed to determine whether hypothermia treatment could remain effective within 12 h after birth.[ncbi.nlm.nih.gov]

Prognosis

  • HIE patients were further divided into two groups: poor prognosis and better prognosis.[ncbi.nlm.nih.gov]
  • Prognosis relates to the severity of the hemorrhage as well as any preceding hypoxic-ischemic insults and the subsequent occurrence of hydrocephalus.[ncbi.nlm.nih.gov]
  • Neurophysiologic tests can be of value in the clinical decisions and analysis of functional prognosis of patients with hypoxic-ischemic encephalopathy.[ncbi.nlm.nih.gov]
  • Among the 46 infants with increased cerebral echodensities, PCr/Pi was more likely to be low, and prognosis poor, in infants whose echodensities were diffuse or indicated intraparenchymal hemorrhage than in infants whose echodensities were consistent[ncbi.nlm.nih.gov]
  • These data were compared between the affected infants and controls and were related to the degree of HIE to determine their utilities as biochemical markers for early diagnosis and prognosis.[ncbi.nlm.nih.gov]

Etiology

  • EEG monitoring and MRI are important tools in determining the etiology of encephalopathy and prognosis of the infant.[ncbi.nlm.nih.gov]
  • The predominant etiological process is hypoxic-ischemic encephalopathy. Prognosis is related primarily to the neurological disease responsible for the seizures.[ncbi.nlm.nih.gov]
  • Included in the study group were five patients with sickle cell disease, four with congenital heart disease, four with hypotensive episodes with various etiologies, three with sepsis, and two with encephalitis or meningitis.[ncbi.nlm.nih.gov]
  • When BISi 10, a neurological etiology death dominated independent of cardiac risk group.[researchgate.net]
  • Etiology and prognosis of alpha coma. Neurology 1988;38:773-7. [ PUBMED ] 5. Kaplan PW, Genoud D, Ho TW, Jallon P. Etiology, neurologic correlations, and prognosis in alpha coma. Clin Neurophysiol 1999;110:205-13. [ PUBMED ] 6.[neurologyindia.com]

Epidemiology

  • KEYWORDS: all epilepsy / seizures; childhood stroke; cohort studies; epilepsy; risk factors in epidemiology[ncbi.nlm.nih.gov]
  • Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication.[cambridge.org]
  • In comparison, epidemiologic studies have suggested that 70% of causation is related to chronic antenatal factors.[pediatrics.aappublications.org]
  • Journal of Clinical Epidemiology 2005; 58: 982–990. pmid:16168343 View Article PubMed/NCBI Google Scholar 23. Hellström-Westas L, Rosén I, Svenningsen NW.[journals.plos.org]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiology of HIBI encompasses a heterogeneous cascade that culminates in secondary brain injury and neuronal cell death. This begins with primary injury to the brain caused by the immediate cessation of cerebral blood flow following CA.[ncbi.nlm.nih.gov]
  • Understanding pathophysiology of the brain damage is essential for the early detection of patients with high risk for HIE and development of strategies for their treatments.[ncbi.nlm.nih.gov]
  • This review describes the pathophysiological and molecular basis of hypoxic ischemic brain injury, and differentiates between the mechanisms of injury by cardiac arrest, pure respiratory arrest, and arrest secondary to cytotoxicity (e.g. carbon monoxide[ncbi.nlm.nih.gov]
  • Neuroinflammatory response to acute cerebral HI is a major contributor to the pathophysiology of perinatal brain injury.[ncbi.nlm.nih.gov]
  • These studies have broad implications for understanding pathophysiological mechanisms of disease.[ncbi.nlm.nih.gov]

Prevention

  • After an infant is born with HIE the question of whether it was predictable, or preventable, is often raised.[ncbi.nlm.nih.gov]
  • Application of this knowledge will allow us to identify strategies for early intervention and prevent the course of damage caused by hypoxic-ischemic injury.[ncbi.nlm.nih.gov]
  • Early interventions should focus on the preservation of energy metabolism, the reduction of glutamate excitotoxicity and oxidative stress, the maintenance of calcium homeostasis, and the prevention of apoptosis.[ncbi.nlm.nih.gov]
  • CONCLUSION: This study confirmed that TH performs a role in the prevention of inflammatory process by way of maintaining proinflammatory cytokine IL-6 at low levels and anti-inflammatory cytokines IL-10 at high levels.[ncbi.nlm.nih.gov]
  • The number needed to treat is approximately 6 to 7 to prevent one child from either death or disability at age 18 to 22 months. EEG monitoring and MRI are important tools in determining the etiology of encephalopathy and prognosis of the infant.[ncbi.nlm.nih.gov]

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