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Hypoxic-ischaemic brain injury
  1. Robin S Howard1,
  2. Paul A Holmes1,
  3. Michalis A Koutroumanidis2
  1. 1Consultant Neurologist, Department of Neurology, Guy's and St Thomas' NHS Trust, London, UK
  2. 2Consultant Neurophysiologist, Department of Neurology, Guy's and St Thomas' NHS Trust, London, UK
  1. Correspondence to Dr R S Howard, Department of Neurology, Guy's and St Thomas' NHS Trust, London SE1 7EH, UK; robin.howard{at}gstt.nhs.uk

Abstract

Hypoxic–ischaemic brain injury is common and usually due to cardiac arrest or profound hypotension. The clinical pattern and outcome depend on the severity of the initial insult, the effectiveness of immediate resuscitation and transfer, and the post-resuscitation management on the intensive care unit. Clinical assessment is difficult and so often these days compromised by sedation, neuromuscular blockade, ventilation, hypothermia and inotropic management. Investigations can add valuable information, in particular brain MRI shows characteristic patterns depending on the severity of the injury and the timing of imaging. EEG patterns may also suggest the possibility of a good outcome. There is no entirely reliable algorithm of clinical signs or investigations which allow a definitive prognosis but the combination of careful repeated observations and appropriate ancillary investigations allows the neurologist to give an informed and accurate opinion of the likely outcome, and to advise on management. Overall, the prognosis is extremely poor and only a quarter of patients survive to hospital discharge, and often even then with severe neurological or cognitive deficits.

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Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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