Next Close

Hypoxic Ischemic Encephalopathy

(Cerebral Hypoxia; HIE)

Pronounced: hye-POK-sik is-KEM-ik en-sef-a-lo-path-ee

Definition

Hypoxic ischemic encephalopathy (HIE) is a condition in which the entire brain does not receive enough oxygen. But, it is not completely deprived. This particular condition refers to an oxygen deficiency to the brain as a whole, rather than a part of the brain. Although the term most often refers to injury sustained by new born infants, HIE can be used to described any injury from low oxygen.

HIE can be fatal. Within as little as five minutes of oxygen deprivation, brain cells can begin dying. The disease can also cause long-term damage, including mental retardation, delayed development, seizures, and cerebral palsy.

Blood Supply to the Brain

Causes

There are a variety of causes of HIE. Any injury and many health conditions can potentially cause oxygen deprivation to the brain. Some common causes are:

Injury or complication during birth
Respiratory failure
Blocked or ruptured blood vessel
Carbon monoxide or cyanide poisoning
Drug overdose
Drowning
Lack of oxygen due to smoke inhalation
Extremely low blood pressure
Strangulation
Cardiac arrest
Carbon monoxide poisoning
High altitudes
Choking
Compression or injury to the trachea that reduces or stops breathing
Complications from general anesthesia
Diseases that cause paralysis of the respiratory organs or muscles (eg, myasthenia gravis, Guillain-Barre syndrome)

Risk Factors

Any injury, complication, or condition that causes the brain to have a reduction in blood flow and oxygen deprivation is a risk factor for HIE.

Symptoms

Symptoms include:

Mild case:
Difficulty concentrating or paying attention
Poor judgment
Poor coordination
Euphoria
Extreme lethargy
Severe oxygen deprivation:
Seizures
Coma
No brain stem reflexes (eg, breathing, responding to light)
Only blood pressure and heart function reflexes are functioning

Diagnosis

The doctor will work quickly to do a physical exam. Typically, the history is the most important factor in making the diagnosis.

Tests may include the following:

CT scan —a scan that uses x-rays and computer software to make pictures of your brain
MRI scan —a test that uses magnetic waves to make pictures of structures inside the brain
Electrocardiogram (EKG, ECG) —a test that records the heart’s activity by measuring electrical currents through the heart muscle
Echocardiogram —a test that uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart
Blood tests, including arterial blood gases and blood glucose levels
Electroencephalogram (EEG) —a test that records the brain’s activity by measuring electrical currents through the brain
Ultrasound—a test that uses sound waves to evaluate blood flow in the vessels going to the brain or within the brain

Treatment

Treatment depends on the underlying cause of the condition, as well as the severity of the damage to the brain. Treatment options include:

Life-sustaining treatment—If brain function has stopped but damage is not yet extensive, life-sustaining treatment is administered.
Mechanical ventilation—This may be needed to sustain breathing.
Treatments for the circulatory system—Treatments are administered to maintain heart function and control blood pressure.
Seizure control—Medicine and general anesthesia may be administered to control seizures.
Cooling—Hypoxic brain damage is often caused by heat. Cooling blankets or other means of cooling may be applied to reduce the body's temperature.
Hyperbaric oxygen treatment—This treatment is used in cases of carbon monoxide poisoning.

Prevention

In most cases, HIE is unexpected and cannot be prevented. To prevent significant or long-term brain damage once the oxygen supply has been reduced, CPR may be administered.

RESOURCES:

Brain Injury Association of America
http://www.biausa.org/

National Institute of Neurological Disorders and Stroke
http://www.ninds.nih.gov/

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca/index_e.html/

Ontario Brain Injury Association
http://www.obia.on.ca/

REFERENCES:

Brain injury secondary to carotid intervention [review]. J Endovasc Ther . 2007;14:219-231.

Cerebral hypoxia. US National Library of Medicine, Medline Plus website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/001435.htm. Updated September 2008. Accessed January 21, 2010.

Edwards AD. The discovery of hypothermic neural rescue therapy for peri-natal hypoxic-ischemic encephalopathy. Semin Pediatr neurol. 2009;16(4):200-206.

Harrington DJ, Redman CW, Mouldan M, Greenwood CE. The long-term outcome in surviving infants with Apgar zero at 10 minutes: a systematic review of the literature and hospital-based cohort [review]. Am J Obstet Gynecol . 2007;196:463.e1-5.

Hemphill J, Smith W. Neurologic critical care, including hypoxic-ischemic encephalopathy and subarachnoid hemorrhage. In: Fauci AS, Braunwald E, Kasper DL, et al. Harrison's Principles of Internal Medicine. 17th ed. New York, NY: McGraw-Hill; 2005: chap 269.

Hypoxic ischemic encephalopathy (HIE). Neurographics website. Available at: http://www.neurographics.org/2/1/1/4.shtml . Accessed June 2, 2007.

Itoo BA, Al-Hawsawi ZM, Khan AH. Hypoxic ischemic encephalopathy. Incidence and risk factors in North Western Saudi Arabia. Saudi Medical Journal. 2003;24:147-153.

Jain K. Hyperbaric oxygenation for the treatment of stroke. In: Gilman S, ed. MedLink Neurology. San Diego, CA: MedLink Corporation. MedLink website. Available at: http://www.medlink.com . Accessed February 1, 2009.

Puohit D, Silverstein S. Perinatal hypoxic-ischemic encephalopathy. In: Gilman S, ed. MedLink Neurology. San Diego, CA: MedLink Corporation. MedLink website. Available at: http://www.medlink.com. Accessed August 10, 2007.

Schulzke SM, Rao S, Patole SK. A systematic review of cooling for neuroprotection in neonates with hypoxic ischemic encephalopathy-are we there yet? BMC Pediatr . 2007;7:30.

Last reviewed January 2010 by Rimas Lukas, MD
Last Updated: 1/21/2010

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

To send comments or feedback to our Editorial Team regarding the content please email us at healthlibrarysupport@ebscohost.com.


Patient's Name
Healthcare Provider's Name
Department
Who to Call
Notes