Hypoxicischemic Encephalopaty

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Hypoxic-ischemic Encephalopaty

• Gilbert Handal, M.D.

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Definition

• Interruption of vital nutrients to the brain that
  result on neuronal damage by decreased
  oxygenation or lack of perfusion

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Causes

• The most frequent causes are
• Acute airway obstruction croup F.B. Trauma
• Drowning
• Pneumonia inhalation, bacterial, Bronchiolitis
• Choking accidental Non accidental

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Causes (Continued)

• Asthma
• Other causes of CPA
• Myocarditis
• Hypovolemic shock
• Burns
• Overdoses
• Head trauma
• Sepsis
• CNS infections

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Pathophysiology
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HIE 1o Neuronal death Reperfusion and
neuronal damage (days) (Free Radicals, No3
etc) The most important prognostic factor is
the duration of the HIE
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History

• Time from
• Accident
• Identification of CPR
• CPR success? Medications?
• Physical findings
• Heart beat
• Respiratory effort
• Pupils
• Seizures
• Place of accident

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Physical Examination
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• V.S.
• Complete Systems Revision
• Trauma
• Unequal Breathing Sounds
• Heart Rhythm
• Neurologic Examination
• Glasgow Coma Scale
• Children
• Infant

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Brain death Criteria

• PEX No evidence or cortical or brainstem
  function
• Pupils Fixed (midsize or dilated)
• Studies
• Apnea test (1st Proxygenation with FiO2 1.0)
• Isoelectric EEG
• 2 Physicians present

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Outcome

• Good recovery
• Moderate disability
• Severe disability, dependence on others!
• Persistent vegetative state
• Death

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Prognostic Factors

• Glasgow coma scale at presentation 5-6
• Ph on presentation lt7.1
• Hyperglycemia gt250
• Neurologic examination
• Corneal reflex day 3
• Pupilary reaction to light day 3
• Oculovestibular reflexes day 3
• Eyes opening day 7

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• In near drowning (worse prognosis)
• Prolonged immersion
• Anoxia/A systole gt 25 minutes
• Water to gt 10oc
• Glasgow lt 4
• Ph on presentation gt 7.10
• Bs gt 250
• Coma duration gt 24 hours

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• Evoked potentials Somato sensory evoked (SSPE)
  or BEAR
• EEG repeated 6 12 hours