Hypoxic-ischemic encephalopathy

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


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


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



  • 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.


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


See also


  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.