eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Neonatology
Hypoxic-Ischemic Encephalopathy: Multimedia
Updated: Dec 15, 2008
Multimedia
 | Media file 1:
Fetal response to asphyxia illustrating the
initial redistribution of blood flow to vital organs. With
prolonged asphyxial insult and failure of compensatory
mechanisms, cerebral blood flow falls, leading to ischemic
brain injury. |
 | Media file 2:
Pathophysiology of hypoxic-ischemic brain injury
in the developing brain. During the initial phase of energy
failure, glutamate mediated excitotoxicity and Na+/K+ ATPase
failure lead to necrotic cell death. After transient recovery
of cerebral energy metabolism, a secondary phase of apoptotic
neuronal death occurs. ROS = reactive oxygen
species. |
 | Media file 3: Risk factors for neonatal encephalopathy. |
 | Media file 4: Severe acute hypoxic-ischemic neuronal change in the basal ganglia is noted. Histologic examination reveals severe hypoxic-ischemic neuronal change, characterized by the presence of pyknotic and hyperchromatic nuclei, the loss of cytoplasmic Nissl substance, and neuronal shrinkage and angulation (arrow). These alterations begin to appear approximately 6 hours following hypoxic-ischemic insult. Reactive astrocytosis is evident approximately 24-48 hours after the primary hypoxic-ischemic event. |
 | Media file 5: Significant astrocytosis in the basal ganglia following hypoxic-ischemic insult is observed. An immunohistochemical stain for glial fibrillary acidic protein (GFAP) was performed on the same tissue shown in Media file 4 to demonstrate the prominent gliosis secondary to the hypoxic-ischemic event. GFAP is a useful marker to study astrocytic response to injury. This gliosis of the basal ganglia, along with subsequent hypermyelination, is responsible for the evolution of status marmoratus over months to years. |
 | Media file 6: Bilateral acute infarctions of the frontal lobe are shown. The infarctions depicted in the figure (arrows) are consistent with watershed infarctions secondary to global hypoperfusion. The lesions depicted in the image are consistent with an acute ischemic event, occurring within 24 hours of death. The regions most susceptible to hypoperfusion include the end-artery zones between the anterior, middle, and posterior cerebral arteries. |
 | Media file 7: A prior hypoxic-ischemic event involving the occipital lobe has resulted in a chronic lesion marked by dyslamination, neuronal loss, and disorganized arrangements of myelinated white matter fibers. Grossly, the lesion was marked by preserved gyral crests and involved sulci, resulting in prominent, mushroom-shaped gyri. |
 | Media file 8: A Luxol-Fast Blue stain was performed on the same tissue shown in Media file 7 to demonstrate the haphazard arrangement of myelinated white matter fibers projecting into the gray matter of the occipital cortex. |
 | Media file 9: Randomized controlled trials of therapeutic hypothermia for moderate-to-severe hypoxic-ischemic enephalopathy (HIE). |
 | Media file 10: Periventricular leukomalacia is depicted. This cystic lesion, present in the cingulate cortex, is consistent with periventricular leukomalacia. Note the extensive hemorrhage within the cystic space as well as the hemosiderin-laden macrophages around the lesional rim. |
 | Media file 11: Periventricular leukomalacia is depicted. This figure depicts the lesion seen in Media file 10 at higher magnification. Extensive hemosiderin and reactive astrocytosis is present surrounding the lesion (center of field). Note the proximity of the lesion to the ependymal lining of the lateral ventricle (far right). |
 | Media file 12: Summary of potential neuroprotective strategies. |
More on Hypoxic-Ischemic Encephalopathy |
| Overview: Hypoxic-Ischemic Encephalopathy |
| Differential Diagnoses & Workup: Hypoxic-Ischemic Encephalopathy |
| Treatment & Medication: Hypoxic-Ischemic Encephalopathy |
| Follow-up: Hypoxic-Ischemic Encephalopathy |
 Multimedia: Hypoxic-Ischemic Encephalopathy |
| References |
| « Previous Page |
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Further Reading
Keywords
hypoxic-ischemic encephalopathy, neonatal Encephalopathy, hypothermia, HIE, perinatal asphyxia, birth asphyxia, neonatal asphyxia, hypoxia, acidosis, ischemia, cerebral blood flow, CBF, multiple organ failure, aspiration pneumonia, mental retardation, epilepsy, cerebral palsy, hemiplegia, paraplegia, quadriplegia, stupor coma, poor sucking, seizures, reperfusion injury, tricuspid regurgitation, pulmonary hypertension, renal failure, oliguria, tubular failure, electrolyte imbalances, necrotizing enterocolitis, delayed gastric emptying, thrombocytopenia, coagulopathy
