Abstract
Hypoxia is due to decreased oxygen delivery to the brain which leads to cell injury. Ischemia is characterized by a decreased blood flow and accumulation of toxic cellular metabolites. Various forms of hypoxia are distinguished: hypoxic hypoxia (blood oxygen tension below 40 mmHg), anemic hypoxia (oxygen-carrying hemoglobin falls to half its normal concentration), histotoxic hypoxia (caused by toxic substances), ischemic/stagnant hypoxia (cardiac arrest encephalopathy, transient global ischemia), and non-perfused brain (respirator brain, permanent global ischemia).
Global hypoxia (hypoxic-ischemic injury) presents with watershed zone infarcts in mild cases. Severe hypoxia results in infarcts of basal ganglia, cortex, thalami, hippocampi, and cerebellum. Histologically, neuronal necrosis is characterized by red neurons with shrunken neuronal cell body, presence of ghost neurons, dark neurons. Cortical laminar neuronal necrosis and hypoxic-ischemic leukoencephalopathy broaden the lesion spectrum. Selective regional vulnerability is seen by damage of pyramidal neurons in CA1 sector (Sommer sector) in the hippocampus, neurons of layers III, V, and VI of the neocortex, Purkinje cells of the cerebellum, spiny neurons of the basal ganglia, and of neurons of anterior and dorsomedial nuclei of the thalamus.
The decrease in oxygen leads to a decreased production of ATP, failure of Na+/K+ pump and Ca2+ pump resulting in the entrance of sodium into cells which causes cell swelling. Excitotoxicity due to the excitatory neurotransmitter glutamate depolarizes the neuronal membrane which leads to an excessive influx of sodium, chloride, water, and calcium causing swelling, metabolic dysfunction, and disruption of the cellular membrane. Molecular chaperone proteins and immediate early genes are activated.
Treatment includes standard intensive care, hemodynamic optimization and control of dysrhythmias, hypotension, and low cardiac index. Clinical outcome depends on the severity and duration of the hypoxic event, body temperature, and blood glucose concentration.
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Weis, S. et al. (2019). Vascular Disorders: Hypoxia. In: Imaging Brain Diseases. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1544-2_17
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DOI: https://doi.org/10.1007/978-3-7091-1544-2_17
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