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Cerebral hypoxia
Definition
Cerebral hypoxia occurs when there is not enough oxygen getting to the brain. The brain needs a constant supply of oxygen and nutrients to function.
Cerebral hypoxia refers to the outer part of the brain, an area called the cerebral hemisphere. However, the term is often used to refer to a lack of oxygen supply to the entire brain.
Alternative Names
Hypoxic encephalopathy; Anoxic encephalopathy
Causes
In cerebral hypoxia, sometimes only the oxygen supply is interrupted. This can be caused by:
- Breathing in smoke (smoke inhalation), such as during a fire
- Carbon monoxide poisoning
- Choking
- Diseases that prevent movement (paralysis) of the breathing muscles, such as amyotrophic lateral sclerosis (ALS)
- High altitudes
- Pressure on (compression) the windpipe (trachea)
- Strangulation
In other cases, both oxygen and nutrient supply are stopped, caused by:
- Cardiac arrest (when the heart stops pumping)
- Cardiac arrhythmia
- Complications of general anesthesia
- Drowning
- Drug overdose
- Injuries to a newborn that occurred before, during, or soon after birth (See: Cerebral palsy)
- Stroke
- Very low blood pressure
Brain cells are extremely sensitive to a lack of oxygen. Some brain cells start dying less than 5 minutes after their oxygen supply disappears. As a result, brain hypoxia can rapidly cause severe brain damage or death.
Symptoms
Symptoms of mild cerebral hypoxia include:
- Change in attention (inattentiveness)
- Poor judgment
- Uncoordinated movement
Symptoms of severe cerebral hypoxia include:
- Complete unawareness and unresponsiveness (coma)
- No breathing
- No response of the pupils of the eye to light
Exams and Tests
Cerebral hypoxia can usually be diagnosed based on the person's medical history and a physical exam. Tests are done to determine the cause of the hypoxia, and may include:
- Angiogram of the brain
- Blood tests, including arterial blood gases and blood chemical levels
- CT scan of the head
- Echocardiogram
- Electrocardiogram (ECG), a measurement of the heart's electrical activity
- Electroencephalogram (EEG), a test of brain waves that can identify seizures and show how well brain cells work
- Evoked potentials, a test that determines whether certain sensations such as vision and touch reach the brain
- Magnetic resonance imaging (MRI) of the head
If only blood pressure and heart function remain, the brain may be completely dead.
Treatment
Cerebral hypoxia is an emergency condition that need to be treated right away. The sooner the oxygen supply is restored to the brain, the lower the risk of severe brain damage and death.
Treatment depends on the cause of the hypoxia. Basic life support is most important. Treatment involves:
- Breathing assistance (mechanical ventilation) and oxygen
- Controlling the heart rate and rhythm
- Fluids, blood products, or medications to raise blood pressure if it is low
- Medications including phenytoin, phenobarbital, valproic acid, or general anesthetics to calm seizures
Sometimes a person with cerebral hypoxia is cooled to slow down the activity of the brain cells and decrease their need for oxygen. However, the benefit of this treatment has not been firmly established.
Outlook (Prognosis)
The outlook depends on the extent of the brain injury. This is determined by how long the brain lacked oxygen, and whether nutrition to the brain was also affected.
If the brain lacked oxygen for only a very brief period of time, a coma may be reversible and the person may have a full or partial return of function. Some patients recover many functions, but have abnormal movements such as twitching or jerking, called myoclonus. Seizures may sometimes occur, and may be continuous (status epilepticus).
Most people who make a full recovery were only briefly unconscious. The longer a person is unconscious, the higher the risk for death or brain death, and the lower the chances of recovery.
Possible Complications
Complications of cerebral hypoxia include a prolonged vegetative state. This means the person may have basic life functions such as breathing, blood pressure, sleep-wake cycle, and eye opening, but the person is not alert and does not respond to his or her surroundings. Such patients usually die within a year, although some may survive longer.
Length of survival depends partly on how much care is taken to prevent other problems. Major complications may include:
- Bed sores
- Clots in the veins (deep vein thrombosis)
- Lung infections (pneumonia)
- Malnutrition
When to Contact a Medical Professional
Cerebral hypoxia is a medical emergency. Call 911 immediately if someone is losing consciousness or has other symptoms of cerebral hypoxia.
Prevention
Prevention depends on the specific cause of hypoxia. Unfortunately, hypoxia is usually unexpected. This makes the condition somewhat difficult to prevent.
Cardiopulmonary resuscitation (CPR) can be lifesaving, especially when it is started right away.
References
Bernat JL. Coma, vegetative state, and brain death. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 411.
Wijdicks EFM, Fugate JE. Anoxic-ischemic encephalopathy. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley’s Neurology in Clinical Practice. 6th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 55.
Zivin JA. Approach to cerebrovascular diseases. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 413.
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Luc Jasmin, MD, PhD, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, and Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
