Difference between revisions of "Hypoxic-ischemic encephalopathy"

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#redirect [[Neuropathology#Hypoxic-ischemic_encephalopathy]]
'''Hypoxic-ischemic encephalopathy''', abbreviated '''HIE''', is a common [[neuropathology]] encountered at [[autopsy]].


==General==
*Often due to ''cardiac arrest'', i.e. global ischemia.
*Triple watershed area = parieto-occipital cortex, extrastriate occipital cortex.
Note:
*''Hypoxia'' = blood decreased oxygen carrying capacity,<ref name=Ref_PCPBoD8_10>{{Ref PCPBoD8|10}}</ref> e.g. [[anemia]].
*''Ischemia'' = decreased blood flow.<ref name=Ref_PCPBoD8_10>{{Ref PCPBoD8|10}}</ref>
*Either ''or'' both = less oxygen delivery to tissue.
==Microscopic==
Features:
*Hippocampal ischemic changes (in adults):
**Loss of neurons in CA1, CA3 and CA4 +/- "cavitation".
***Neuronal loss: No blue (nuclei) where there should be some.
***Cavitation: bubbles/clear spaces where there should be none.
**CA2 neurons preserved/resistant.
*Purkinje cell loss in the cerebellum and [[Bergmann gliosis]].
*"Anoxic neurons".<ref>URL: [http://www.neuropathologyweb.org/chapter2/chapter2aHIE.html http://www.neuropathologyweb.org/chapter2/chapter2aHIE.html]. Accessed on: 12 July 2010.</ref>
**Shrunken neurons with intensely eosinophilic cytoplasm and pyknotic (shrunken) nuclei.
*Pseudolaminar necrosis - (uncontrolled) cell death in the cerebral cortex in a band-like pattern,<ref>Hypoxic and Ischemic Encephalopathy. neuropathology.neoucom.edu. Accessed on: 29 December 2010.</ref> with a relative preservation of cells immediately adjacent to the meninges.
Notes:
*Neurons of ''subiculum'' in adults - usu. normal (as they are resistant to ischemic changes).
===Images===
*Anoxic neurons:
**[http://www.neuropathologyweb.org/chapter2/images2/2-1HIE.jpg Anoxic neurons (neuropathologyweb.org)].
**[http://moon.ouhsc.edu/kfung/iacp-olp/APAQ-Images/N1-MS-01-16.gif Anoxic neurons (ouhsc.edu)].<ref>URL: [http://moon.ouhsc.edu/kfung/iacp-olp/apaq-text/N1-MS-01-16-Ans.htm http://moon.ouhsc.edu/kfung/iacp-olp/apaq-text/N1-MS-01-16-Ans.htm] and [http://moon.ouhsc.edu/kfung/iacp-olp/apaq-text/n1-ms-01.htm http://moon.ouhsc.edu/kfung/iacp-olp/apaq-text/n1-ms-01.htm]. Accessed on: 31 October 2010.</ref>
<gallery>
Image:Alzheimer_type_II_astrocyte_high_mag_cropped.jpg | Anoxic neurons. (WC)
</gallery>
*Hippocampal ischemic changes:
**[http://www.neuropathologyweb.org/chapter2/images2/2-hippoHIE.jpg Hippocampus in HIE (neuropathologyweb.org)].<ref>URL: [http://www.neuropathologyweb.org/chapter2/chapter2aHIE.html http://www.neuropathologyweb.org/chapter2/chapter2aHIE.html]. Accessed on: 14 January 2011.</ref>
*Pseudolaminar necrosis:
<gallery>
Image:Cortical_pseudolaminar_necrosis_-_lfb_-_very_low_mag.jpg | Pseudolaminar necrosis - very low mag. (WC)
Image:Cortical_pseudolaminar_necrosis_-_lfb_-_intermed_mag.jpg | Pseudolaminar necrosis - intermed. mag. (WC)
</gallery>
==See also==
*[[Neuropathology]].
==References==
{{Reflist|2}}
[[Category:Neuropathology]]
[[Category:Diagnosis]]
[[Category:Diagnosis]]

Latest revision as of 07:24, 9 December 2014

Hypoxic-ischemic encephalopathy, abbreviated HIE, is a common neuropathology encountered at autopsy.

General

  • Often due to cardiac arrest, i.e. global ischemia.
  • Triple watershed area = parieto-occipital cortex, extrastriate occipital cortex.

Note:

  • Hypoxia = blood decreased oxygen carrying capacity,[1] e.g. anemia.
  • Ischemia = decreased blood flow.[1]
  • Either or both = less oxygen delivery to tissue.

Microscopic

Features:

  • Hippocampal ischemic changes (in adults):
    • Loss of neurons in CA1, CA3 and CA4 +/- "cavitation".
      • Neuronal loss: No blue (nuclei) where there should be some.
      • Cavitation: bubbles/clear spaces where there should be none.
    • CA2 neurons preserved/resistant.
  • Purkinje cell loss in the cerebellum and Bergmann gliosis.
  • "Anoxic neurons".[2]
    • Shrunken neurons with intensely eosinophilic cytoplasm and pyknotic (shrunken) nuclei.
  • Pseudolaminar necrosis - (uncontrolled) cell death in the cerebral cortex in a band-like pattern,[3] with a relative preservation of cells immediately adjacent to the meninges.

Notes:

  • Neurons of subiculum in adults - usu. normal (as they are resistant to ischemic changes).

Images

  • Anoxic neurons. (WC)

  • Pseudolaminar necrosis - very low mag. (WC)

  • Pseudolaminar necrosis - intermed. mag. (WC)

See also

References

  1. ↑ 1.0 1.1 Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 10. ISBN 978-1416054542.
  2. ↑ URL: http://www.neuropathologyweb.org/chapter2/chapter2aHIE.html. Accessed on: 12 July 2010.
  3. ↑ Hypoxic and Ischemic Encephalopathy. neuropathology.neoucom.edu. Accessed on: 29 December 2010.
  4. ↑ URL: http://moon.ouhsc.edu/kfung/iacp-olp/apaq-text/N1-MS-01-16-Ans.htm and http://moon.ouhsc.edu/kfung/iacp-olp/apaq-text/n1-ms-01.htm. Accessed on: 31 October 2010.
  5. ↑ URL: http://www.neuropathologyweb.org/chapter2/chapter2aHIE.html. Accessed on: 14 January 2011.
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