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Elsa AACN > Ch 28 Hypoxic and Ischemic brain injury > Flashcards

Ch 28 Hypoxic and Ischemic brain injury Flashcards

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1
Q

Definition of anoxia

A

Complete lack of oxygen in blood due to profound and sudden medical events such as cardiac arrest, loss of perfusion pressure

Hanging, strangulation

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2
Q

Definition of hypoxia

A

Deficient amount of oxygen available in the blood supply to the brain.

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3
Q

Hypoxemia definition

A

Reduced partial pressure of oxygen in blood.
(Low levels of oxygen in blood)
Hypoxemia can lead to hypoxia

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4
Q

Ischemia definition

A

Failure of perfusion of blood through the cerebral vessels to tissue.

Ischemia and anoxia are usually involved in sudden cardiac arrest

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5
Q

What is the partial pressure of arterial oxygen and healthy adults?

A

95 to 100 mm Hg

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6
Q

What happens when partial pressure of arterial oxygen drops or is disrupted?

A

Homeostatic protective mechanisms are triggered

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7
Q

Which parts of the brain regions are more vulnerable to hypoxia and ischemia?

A

Brain regions with high metabolic demands

Those that are at the distal end of cerebral arteries, watershed regions

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8
Q

Sample of brain regions that are highly vulnerable to hypoxia and Ischemia?

A 
Neo cortex
Hippocampus
Basal ganglia
Cerebellar regions
Visual cortex
Thalamus
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9
Q

What is a common response of the brain following anoxic or hypoxic insult?

A

Edema

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10
Q

What else may happen during anoxia and hypoxia?

A

Edema, a series of metabolic events which lead to
Wallerian degeneration
Accelerated apoptosis
Atrophy

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11
Q

Does atrophy and degeneration happen acutely or span over a longer period?

A

It evolves over the course of many weeks and months

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12
Q

Neural imaging findings in apraxia or hypoxia

A

Loss of distinction between white and gray matter in the cortex
Damage of basal ganglia in neo cortex regions

Results that come later-

Hippocampal damage
Diffuse atrophy
White matter tracks vulnerable to carbon monoxide poisoning

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13
Q

What used to be considered the hallmark feature of hypoxic damage

A

Hippocampal damage.

This has been refuted in studies.

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14
Q

Other areas that are frequently damaged?

A

Watershed cortex

basal ganglia

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15
Q

Most energy required by neurons is derived from hydrolysis of what chemical

A

Adenosine triphosphate ATP

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16
Q

Does the brain have any inherent energy stores?

A

No, so it’s critically dependent on uninterrupted flow of oxygen and glucose

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17
Q

When there is a critical shortage of oxygen and glucose supply to neurons, what would result

A

Neuronal death

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18
Q

Describe the secondary toxic process that is triggered as a result of neuronal death?

A

Sodium and calcium pumps fail

depolarization of neuronal membrane and release of excessive glutamate.

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19
Q

How is glutamate related to toxic process in hypoxia and anoxia

A

Glutamate is the most common excitatory neurotransmitter, but at excessive levels it could be toxic to neurons

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20
Q

What else is involved in the toxic process?

A

Lactic acidosis
Wallerian degeneration
Necrosis
Apoptosis

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21
Q

Additional potential sources of damage to the brain after circulation is restored?

A

Secondary hypoxia
-after circulation returns, blood flow may go through a period of 30 to 50% reduction

Reperfusion injury
-After re-perfusion, some processes happen that may cause further damage such as
1 free radical formation
2 nitric oxide toxicity,
3 additional glutamate release,
4 edema and micro hemorrhages,
5 impaired ability to remove toxic metabolic stuff

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22
Q

What shares many of the same affects as hypoxia and ischemia?

A

Carbon monoxide poisoning

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23
Q

Carbon monoxide has a very high for affinity for binding with what

A

Hemoglobin

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24
Q

After carbon monoxide binds with hemoglobin, what would be formed?

A

Carboxyhemoglobin

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25
Once carboxyhemoglobin rises above 20 to 30% of total hemoglobin in the blood, what happens
Levels above 50% will result in coma and other severe CNs effects
26
What else happens with carbon monoxide poisoning?
Delayed neurologic deterioration which happens 1 to 3 weeks after severe exposure. Basal ganglia damage Hippocampal atrophy and generalized brain atrophy Neuropsych deficits including attention, processing, executive functions, memory
27
Incidence rates for hypoxia and ischemia
Extremely difficult to estimate
28
Percentage of people surviving with permanent brain damage after anoxic or hypoxic injury
50%
29
Hypoxia that does not involve collapse or cessation of functioning of the circulatory system will typically result in less or more damage?
If it does not involve the collapse of circulatory system, damage is less
30
Under what circumstance is hypoxia not going to damage CNS?
If it is not severe enough to disrupt consciousness
31
Examples of severe hypoxia cases
Sudden cardiac arrest | Acute respiratory distress syndrome
32
What happens after a loss of consciousness happens?
Once the brain is deprived of oxygen for several minutes, damage progresses rapidly, and if the underlying condition is not quickly reversed, brain death or minimally conscious state would result.
33
What happens when someone wakes up from a prolonged coma after hypoxia or ischemia?
Long lasting cond of functional disability extrapyramidal syndrome’s such as parkinsonism
34
What environmental factor can help reduce likelihood of permanent damage the brain after hypoxia?
If event Occurs in a hospital setting and receives rapid and effective resuscitation
35
Examples of chronic disease related to chronic hypoxic an ischemic conditions
Obstructive sleep apnea and COPD
36
Chronic obstructive pulmonary disease COPD symptoms
Emphysema, neural muscular weakness, fibrosing lung disease Persistent respiratory acidosis with reduced oxygen saturation an elevator carbon dioxide Cognitive deficits may not occur in mild cases they do not produce persistent hypoxia Severe COPD cases result in cognitive impairment
37
Obstructive sleep apnea symptoms
Recurrent episodes of blood oxygen desaturation due to total apnea or partial apnea breathing cessation
38
Neurological correlates of COPD
Greater risk for a white matter hyperintensities and cognitive impairment.
39
How does CPAP machine help with COPD
Reduces episodes of breathing disruption Reduces oxygen desaturation during sleep Improves daytime sleepiness
40
Factors that are associated with poor outcome after hypoxic and ischemic event
GCS score of 3 to 5 after 24 hours post onset No pupillary response on Day 3 post injury Sustained abnormal EYE functions Lower cranial nerve or brainstem dysfunction Seizures or Myoclonus Alpha coma EEG pattern
41
Relationship between Age and recovery after hypoxic or anoxic event
Negatively correlated
42
Do patients with severe hypoxic ischemic injury return to independence?
No, recovery curves are flat
43
Delayed Post hypoxic leukoencephalopathy DPHL
Condition that is sometimes seen after anoxia or hypoxia. Commonly seen after CO poisoning Can occur due to any etiology producing prolonged hypo oxygenation Patient initially makes a good recovery and could resume normal functioning followed by an abrupt onset of progressive neurologic decline involving parkinsonism or akinetic mutism with prominent cognitive impairment.
44
What can you expect on imaging studies for delete posts hypoxic leukoencephalopathy?
Prominent white matter demyelination in frontal parietal region
45
Comparison of outcomes between TBI and Hypoxia anoxia
Difference Amount of tissue loss is more critical in anoxia (than TBI) in determining outcome Hypoxia cases are more likely to be referred to residential care than TBI Hypoxia cases perform worse on all measures of functional outcome than TBI Hypoxia cases have significantly lower FIM gains relative to TBI Same Measures of memory correlate with hippocampal atrophy in both conditions Intelligence correlates with whole brain volume in both
46
Assessment of hypoxia anoxia
CT, MRI of the brain do not reveal significant changes initially. ``` Abnormalities often take weeks or months to show on scans:  White matter changes Corpus callosum atrophy Cortical edema Cerebellar lesions Basal ganglia lesions Thalamic lesions Hippocampal atrophy ```
47
Which cognitive domain is less likely a problem for anoxia
Aphasia
48
Outcomes of sudden cardiac arrest and ARDS
More than 30% With sudden cardiac arrest and ARDS show generalized cognitive impairment Memory, attention, processing speed
49
Outcomes of severe hypoxia and anoxia
More than 50% of people have changes in memory, 30% show personality changes
50
What percent of people can regain full independence after hypoxia ischemia
<50%
51
Neuropsychological assessment results in hypoxic ischemic injury
``` Memory is most common Attention Executive dysfunction Visual spatial deficits Overall decline ```
52
Do pure amnestic syndromes happen often following anoxia hypoxia?
No, rarely happens Cognitive impairment is typically more extensive due to diffuse cerebral injury
53
Do all patients suffer from memory impairment?
No a subset of patients do not have memory impairment but display motor or cognitive impairments and other domains
54
Which parts of the brain are at high-risk for injury in hypoxia and anoxia?
Basal ganglia and cerebellum
55
Describe sensorimotor functioning after hypoxia and anoxia
Severe hypoxic injury can cause spastic Quadripareais Ataxia Parkinsonism syndromes
56
Emotion and personality changes after hypoxic an anoxic injury?
Anosognosia, self awareness impairment Depression Emotional and behavioral dysregulation PTSD may be seen in mild hypoxia and anoxia injuries following traumatic event
57
Example of medication for hypoxia anoxia
Methylphenidate Stimulants Acetylcholinesterase inhibitor (aricept) SSRIs or anti-convulsant for mood stabilization
58
Brains of infants and children require higher or lower percentage of oxygen than adults?
Infants to kids age 4 need | > 30% total body oxygen consumption in their brains
59
Outcomes of perinatal anoxic hypoxic injury?
Later development of ADHD
60
Outcome of neonatal hypoxia
Developmental disorder and impaired cognition
61
What is the strongest predictor of long-term outcome in brain injury in neonates?
If there is injury in basal ganglia and thalamus
62
 Are older brains more or less able to recover from hypoxic brain injury?
Older people are less likely to repair or recover from hypoxic brain injury, permanent and severe cognitive deficits due to reduce cerebral reserve
63
Definition of acute respiratory distress syndrome ARDS
Severe, life-threatening medical condition in which lungs are compromised or damaged and are unable to supply enough oxygen to arterial blood. Result in anoxic hypoxic damage to the brain

Elsa AACN (35 decks)

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