Hypoxic brain injury

Definition - What is hypoxic brain injury?

Hypoxic brain injury describes an impairment of brain parts that is caused by an insufficient supply of oxygen to the respective area.

As a result of the inadequate supply of oxygen to the tissue, called hypoxia, cells are damaged and can deteriorate as a result. In other words, the tissue dies. Because the brain is predominantly made up of nerve cells and they can only recover very slowly if at all, hypoxia can lead to extensive complications.

Cause - How does such brain damage occur?;

The cause for brain injury is hypoxia. which can be caused by various mechanisms. The most important ones are strokes, traumatic events involving cardiovascular arrest and subsequent resuscitation, or hypoxia that occurs before, during, or after childbirth.

With regard to a stroke, the cause can be a bleeding, for example following an accident, or a thrombotic event. Thrombotic strokes are much more common and happen when a blood clot (thrombus) clogs a blood vessel. As a result, certain areas can no longer be supplied with blood. Hypoxia of the tissue occurs, resulting in brain damage.

Circulatory arrest can be triggered by a variety of circumstances. Here, the heart function stops, making resuscitation with chest compressions and artificial respiration necessary. During the time of non-functioning circulation, hypoxia of various organs sets in, one of which is the brain.

Nowadays, thanks to better resuscitation techniques, there is a steady increase in the number of survivors following resuscitation. Nevertheless, it is estimated that approximately 30-50% of all patients will subsequently suffer from brain injury. This has made the therapy of hypoxic brain injury more relevant.

The embryonic or early infant brain is extremely sensitive to a reduced oxygen supply. Consequently, birth represents a potentially highly dangerous event. Even before birth, the brain can be harmed through the influence of toxic substances such as medications or drugs. During birth, the umbilical cord may get tangled around the child's neck or the airway may be blocked after birth.

Hypoxic brain injury in children 

The reason for brain injury in children is usually so-called asphyxia. The term refers to a lack of oxygen during the period around birth, which includes both damage in the womb and outside of it.

The developing brain is particularly sensitive to the lack of oxygen, as it is largely dependent on it. Not surprisingly, asphyxia is responsible for about 25% of all neonatal deaths.

Depending on the severity and duration of asphyxia, there will be complications of varying degrees. After birth, for instance, infants may exhibit changes in consciousness, muscle tone, or a failure of certain early infantile reflexes.

As the brain regulates all important developmental processes in the body, any damage during this process can result in both mental and physical impairments. Mild asphyxia, however, can also lead to barely noticeable neurological abnormalities.

Symptoms - What symptoms are associated with hypoxic brain injury?

The symptoms of hypoxic brain injury vary according to both the extent of the damage as well as the area involved. Intellectual and motor skills may be impaired.

Particularly after a stroke, many patients develop a so-called hemiparesis. The term describes a half-sided paralysis. This always occurs on the opposite side of the infarct, as the nerve tracts that travel from the brain to the muscles always cross to the opposite side. Hemiparesis may occur in different degrees of severity.

Children with hypoxic brain injury can have severe mental and often physical impairment if the damage is complex. With milder forms, children are usually noticeable for retarded development in comparison to their peers.

Adults may also experience severe or milder symptoms. With severe symptoms, it is not possible for many patients to care for themselves on their own. Accommodation in a nursing home or assistance from others may become necessary.

Patients with milder symptoms can often live alone. For example, physical limitations such as muscle paralysis can be compensated for by certain aids.

Therapy - How do rehabilitation clinics and specialists manage patients?

The therapy depends on the extent of the impairment as well as the individual symptoms. There is a difference between the acute treatment of hypoxia and the therapy of secondary impairments.

Acute treatment focuses on the restoration of oxygen supply and the maintenance of important body functions. 

The therapy of hypoxic brain injury can be done both on an outpatient and inpatient basis as part of a rehabilitation program. The treatment is based on several concepts, including physiotherapeutic, logopedic, ergotherapeutic or psychotherapeutic approaches.

Physical impairments like a change in muscle tone or signs of paralysis can be improved by physiotherapy and individual exercises. In this way, patients with hemiplegia are able to cope with many challenges of daily life and, in some cases, can even walk.

Logopedic treatment may improve speech disorders and also the swallowing process. As part of occupational therapy, patients are taught how to arrange their lives independently. For instance, they learn how to put on and take off their clothes despite physical limitations. This often improves the quality of life markedly for those affected.

Psychotherapy can facilitate many patients' ability to cope with their own illness, making it easier to carry out other therapy options as well.

Chances of recovery, course and prognosis of hypoxic brain injury 

The extent to which hypoxic brain injury will regress or its symptoms be alleviated is determined by the severity of the damage.

Nerve cells can only regenerate very slowly or not at all. This makes the process more difficult, so that complete healing is often not possible.

Through early and intense therapy, however, it is possible to help many patients to cope with their daily lives on their own, despite their limitations.

Besides the extent of the damage, the patient's individual attitude and the way they deal with their condition are often decisive for the prognosis. That is why accompanying psychotherapy as part of interdisciplinary therapy concepts has proven more and more effective.

Which doctors & clinics specialize in the therapy of hypoxic brain injury?

Hypoxic brain injury represents a challenging issue for both the patient as well as their social environment. Adequate and competent medical treatment is essential for the outcome of the disease.

Specialists can improve the quality of life for their patients through rehabilitation measures that focus on the individual needs of the patient. 

We have carefully reviewed the experience of all physicians listed here. Take advantage of this professional expertise and schedule a first appointment with one of our experts swiftly and easily.

Sources:

• Amboss, Nachschlagewerk für Mediziner

• next.amboss.com/de/article/h40cQT;

• Flemmer et al. Gesellschaft für Neonatologie und Pädiatrische Intensivmedizin. Sk2-Leitlinie der Behandlung der neonatalen Asphyxie unter besonderer Berücksichtigung der therapeutischen Hypothermie.

• register.awmf.org/assets/guidelines/024-023l_S2k_Behandlung_der_neonatalen_Aphyxie_unter_besonderer_Ber%C3%BCcksichtigung_der_therapeutischen_Hypothermie_2013-06-abgelaufen.pdf&;

• „NeuroIntensiv“, Schwab/ Schellinger/ Werner/ Unterberg/ Hacke, Springer-Verlag, 1. Auflage, 2008