What are the clinical manifestations of hypoxic-ischemic encephalopathy (HIE) in adults?

From the Guidelines

Hypoxic-ischemic encephalopathy (HIE) in adults manifests through a range of clinical symptoms including altered consciousness, seizures, motor abnormalities, cranial nerve abnormalities, cognitive impairments, and autonomic disturbances, with the prognosis and treatment approach guided by a multidimensional assessment including cerebral imaging, electroencephalogram (EEG), and laboratory tests 1. The clinical manifestations of HIE can vary widely depending on the severity and duration of the hypoxic-ischemic event. Key symptoms include:

• Altered consciousness, ranging from confusion and agitation to coma
• Seizures, which can be generalized tonic-clonic, myoclonic, or non-convulsive in nature, and should be treated with antiepileptic therapy if they affect quality of life, even in patients with a poor prognosis 1
• Motor abnormalities, such as decorticate or decerebrate posturing, hypotonia, hyperreflexia, and positive Babinski signs
• Cranial nerve abnormalities, including pupillary abnormalities, ocular movement disorders, or absent corneal reflexes
• Cognitive impairments, ranging from mild memory deficits to severe global cognitive dysfunction
• Autonomic disturbances, such as temperature dysregulation, blood pressure instability, cardiac arrhythmias, and respiratory pattern abnormalities In patients with HIE, it is crucial to assess for delirium, which can be hypoactive or hyperactive, and to consider non-pharmacological interventions, such as a calm environment and prophylaxis against falls, before initiating drug therapy 1. The prognosis assessment should be performed using a standard prognostic algorithm, and if epileptic seizures are detected, anticonvulsant therapy should be administered at a sufficiently high dose and for a sufficiently long period of time 1.

From the Research

Clinical Manifestations of Hypoxic-Ischemic Encephalopathy in Adults

There are no research papers provided that directly discuss the clinical manifestations of hypoxic-ischemic encephalopathy (HIE) in adults. The studies available focus on HIE in neonates, including its pathophysiology, diagnosis, and treatment.

Available Information on HIE

• HIE in neonates occurs due to impaired cerebral blood flow and oxygen delivery to the brain, resulting in primary and secondary energy failure 2.
• The condition affects 1-6 per 1000 live births in developed countries and 26 per 1000 live births in developing countries 3.
• Clinical manifestations of HIE in neonates include severe neurological impairment, such as cerebral palsy, epilepsy, visual and hearing impairment, cognitive impairment, intellectual, behavioral, and social disorders 3.
• Diagnosis of HIE in neonates involves a combination of perinatal factors, the need for resuscitation, standard neurological examinations, neurophysiological monitoring, neuroimaging methods, and biochemical markers 3.

Treatment of HIE

• Hypothermia therapy is the standard treatment for neonatal HIE, providing partial neuroprotection 4.
• Drug therapy and stem cell therapy have been explored as adjunctive treatments to hypothermia therapy, exhibiting certain neuroprotective effects 4.
• Cardiovascular management following HIE in neonates is crucial, with individualized management utilizing targeted neonatal echocardiography (TnECHO) potentially enhancing care 5.

Note: The provided studies do not directly address the clinical manifestations of HIE in adults, and therefore, the information available is limited to HIE in neonates.