About all

Definition of anoxic encephalopathy. Anoxic Encephalopathy: Causes, Symptoms, and Treatment Options

by alexxlab

What are the main causes of anoxic encephalopathy. How is anoxic encephalopathy diagnosed. What are the treatment options for anoxic encephalopathy. Can anoxic encephalopathy be prevented. What is the prognosis for patients with anoxic encephalopathy.

Understanding Anoxic Encephalopathy: A Comprehensive Overview

Anoxic encephalopathy, also known as cerebral hypoxia or hypoxic-ischemic brain injury, is a serious medical condition that occurs when the brain is deprived of oxygen. This oxygen deprivation can lead to widespread damage to brain cells, potentially resulting in severe neurological deficits or even death if not addressed promptly.

The term “anoxic” refers to a complete lack of oxygen, while “hypoxic” indicates a partial lack of oxygen. In practice, these terms are often used interchangeably when discussing brain injuries resulting from oxygen deprivation. The severity of the condition depends on various factors, including the duration and extent of oxygen deprivation, as well as the specific areas of the brain affected.

Causes and Risk Factors of Anoxic Encephalopathy

Anoxic encephalopathy can result from a variety of causes, all of which lead to a disruption in the brain’s oxygen supply. Some of the most common causes include:

  • Cardiac arrest
  • Stroke
  • Severe asthma attack
  • Drowning or near-drowning incidents
  • Carbon monoxide poisoning
  • Drug overdose
  • Severe blood loss
  • Choking or strangulation
  • Complications during surgery or anesthesia
  • Severe electric shock

Certain medical conditions and lifestyle factors can increase the risk of developing anoxic encephalopathy. These include:

  • Heart disease
  • High blood pressure
  • Diabetes
  • Smoking
  • Obesity
  • Substance abuse
  • Advanced age

Recognizing the Symptoms of Anoxic Encephalopathy

The symptoms of anoxic encephalopathy can vary widely depending on the severity and duration of oxygen deprivation, as well as the specific areas of the brain affected. Some common symptoms include:

  • Loss of consciousness
  • Confusion or disorientation
  • Memory loss
  • Difficulty with coordination and balance
  • Changes in vision or hearing
  • Seizures
  • Headaches
  • Weakness or paralysis in limbs
  • Changes in personality or behavior
  • Difficulty with speech or language comprehension

In severe cases, anoxic encephalopathy can lead to a persistent vegetative state or brain death. It’s crucial to seek immediate medical attention if any signs of oxygen deprivation are observed, as rapid intervention can significantly improve outcomes.

Diagnosing Anoxic Encephalopathy: Tools and Techniques

Diagnosing anoxic encephalopathy involves a comprehensive evaluation of the patient’s medical history, physical examination, and various diagnostic tests. The primary goal is to assess the extent of brain damage and identify the underlying cause of oxygen deprivation.

Medical History and Physical Examination

A thorough review of the patient’s medical history and the circumstances leading to the oxygen deprivation is crucial. This information helps healthcare providers understand the potential cause and duration of the oxygen loss. A physical examination, including neurological assessments, is performed to evaluate the patient’s level of consciousness, reflexes, and overall neurological function.

Diagnostic Imaging

Several imaging techniques may be used to visualize brain structure and function:

  • Computed Tomography (CT) scan: Provides detailed images of the brain and can help identify areas of damage or swelling.
  • Magnetic Resonance Imaging (MRI): Offers high-resolution images of brain tissue and can detect subtle changes that may not be visible on a CT scan.
  • Functional MRI (fMRI): Measures brain activity by detecting changes in blood flow, helping to assess brain function.
  • Positron Emission Tomography (PET) scan: Can show areas of reduced metabolic activity in the brain, indicating damaged or non-functioning regions.

Electroencephalogram (EEG)

An EEG records the brain’s electrical activity and can help detect seizures or abnormal brain wave patterns associated with anoxic encephalopathy.

Blood Tests

Various blood tests may be conducted to check for signs of organ dysfunction, electrolyte imbalances, or other metabolic disturbances that could contribute to or result from the anoxic injury.

Treatment Approaches for Anoxic Encephalopathy

The treatment of anoxic encephalopathy focuses on addressing the underlying cause of oxygen deprivation, minimizing further brain damage, and supporting the patient’s recovery. The specific treatment plan will depend on the severity of the injury and the individual patient’s needs.

Immediate Interventions

In the acute phase, the primary goal is to restore oxygen supply to the brain and stabilize the patient’s condition. This may involve:

  • Cardiopulmonary resuscitation (CPR)
  • Mechanical ventilation
  • Administration of oxygen
  • Medications to support blood pressure and heart function
  • Treatment of the underlying cause (e.g., addressing a cardiac arrest or stroke)

Neuroprotective Strategies

Several neuroprotective measures may be employed to minimize secondary brain damage:

  • Targeted temperature management (therapeutic hypothermia): Lowering the body temperature to reduce metabolic demands and protect brain tissue.
  • Seizure control: Administering anti-epileptic medications to prevent or manage seizures.
  • Blood sugar management: Maintaining optimal blood glucose levels to support brain function.
  • Blood pressure control: Ensuring adequate cerebral perfusion while avoiding excessive blood pressure that could worsen brain swelling.

Rehabilitation and Long-term Care

Once the patient’s condition stabilizes, rehabilitation becomes a crucial component of treatment. This may include:

  • Physical therapy to improve mobility and strength
  • Occupational therapy to help with daily living activities
  • Speech and language therapy to address communication difficulties
  • Cognitive rehabilitation to improve memory and cognitive function
  • Psychological support for both the patient and family members

In some cases, long-term care in a specialized facility may be necessary, particularly for patients with severe neurological deficits.

Prognosis and Recovery from Anoxic Encephalopathy

The prognosis for patients with anoxic encephalopathy can vary widely, depending on factors such as the duration and severity of oxygen deprivation, the specific areas of the brain affected, and the timeliness of treatment. Some patients may experience a full recovery, while others may have lasting neurological deficits or remain in a persistent vegetative state.

Factors Influencing Prognosis

Several factors can impact the likelihood of recovery:

  • Duration of oxygen deprivation: Longer periods of anoxia generally lead to more severe brain damage and poorer outcomes.
  • Age of the patient: Younger patients often have better recovery potential due to greater neuroplasticity.
  • Pre-existing health conditions: Patients with underlying health issues may have a more challenging recovery process.
  • Prompt medical intervention: Rapid treatment can significantly improve outcomes by minimizing brain damage.
  • Quality of post-acute care and rehabilitation: Comprehensive rehabilitation programs can enhance recovery potential.

Recovery Timeline

Recovery from anoxic encephalopathy is often a gradual process that can extend over months or even years. The most significant improvements typically occur in the first six months following the injury, but some patients may continue to show progress for much longer periods.

It’s important to note that recovery patterns can be unpredictable, and each patient’s journey is unique. Some individuals may experience sudden improvements, while others may progress more slowly. Ongoing support and rehabilitation are crucial throughout the recovery process.

Preventing Anoxic Encephalopathy: Strategies and Recommendations

While not all cases of anoxic encephalopathy can be prevented, there are several strategies that can help reduce the risk of oxygen deprivation to the brain:

Cardiovascular Health

Maintaining good cardiovascular health is crucial in preventing conditions that can lead to anoxic encephalopathy. This includes:

  • Regular exercise to strengthen the heart and improve circulation
  • Maintaining a healthy diet low in saturated fats and high in fruits, vegetables, and whole grains
  • Managing blood pressure and cholesterol levels
  • Quitting smoking and limiting alcohol consumption
  • Regular check-ups with healthcare providers to monitor overall health

Safety Measures

Taking appropriate safety precautions can help prevent accidents that may lead to oxygen deprivation:

  • Wearing seatbelts while driving and using appropriate safety equipment during sports and recreational activities
  • Installing carbon monoxide detectors in homes and workplaces
  • Learning and practicing water safety, including swimming skills and proper supervision of children around water
  • Avoiding drug abuse and practicing safe medication use
  • Learning basic first aid and CPR techniques

Management of Chronic Conditions

For individuals with chronic health conditions that may increase the risk of anoxic encephalopathy, proper management is essential:

  • Following prescribed treatment plans for conditions such as heart disease, diabetes, or asthma
  • Regular monitoring of blood sugar levels for diabetics
  • Adhering to medication regimens as prescribed by healthcare providers
  • Attending regular follow-up appointments to assess and adjust treatment plans as needed

Recent Advances in Anoxic Encephalopathy Research and Treatment

The field of anoxic encephalopathy research is continuously evolving, with new insights and treatment approaches emerging. Some recent areas of focus include:

Neuroprotective Agents

Researchers are investigating various pharmacological agents that may help protect brain cells from damage during and after oxygen deprivation. These include:

  • Antioxidants to reduce oxidative stress
  • Anti-inflammatory compounds to mitigate the inflammatory response
  • Neurotrophic factors to promote neuronal survival and regeneration

Stem Cell Therapy

Experimental studies are exploring the potential of stem cell therapy to replace damaged brain cells and promote regeneration. While still in early stages, this approach shows promise for improving outcomes in patients with anoxic encephalopathy.

Advanced Neuroimaging Techniques

New imaging technologies are being developed to provide more detailed information about brain function and recovery potential in patients with anoxic encephalopathy. These include:

  • High-resolution diffusion tensor imaging (DTI) to assess white matter integrity
  • Functional near-infrared spectroscopy (fNIRS) for non-invasive brain monitoring
  • Advanced PET imaging techniques to measure brain metabolism and neurotransmitter activity

Neuromodulation

Techniques such as transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS) are being investigated as potential therapies to enhance recovery and improve neurological function in patients with anoxic encephalopathy.

As research in this field continues to advance, it is hoped that new treatment options will emerge, offering improved outcomes and quality of life for patients affected by anoxic encephalopathy.

Anoxic Encephalopathy – StatPearls – NCBI Bookshelf

Bateman RM, Sharpe MD, Jagger JE, Ellis CG, Solé-Violán J, López-Rodríguez M, Herrera-Ramos E, Ruíz-Hernández J, Borderías L, Horcajada J, González-Quevedo N, Rajas O, Briones M, Rodríguez de Castro F, Rodríguez Gallego C, Esen F, Orhun G, Ergin Ozcan P, Senturk E, Ugur Yilmaz C, Orhan N, Arican N, Kaya M, Kucukerden M, Giris M, Akcan U, Bilgic Gazioglu S, Tuzun E, Riff R, Naamani O, Douvdevani A, Takegawa R, Yoshida H, Hirose T, Yamamoto N, Hagiya H, Ojima M, Akeda Y, Tasaki O, Tomono K, Shimazu T, Ono S, Kubo T, Suda S, Ueno T, Ikeda T, Hirose T, Ogura H, Takahashi H, Ojima M, Kang J, Nakamura Y, Kojima T, Shimazu T, Ikeda T, Suda S, Izutani Y, Ueno T, Ono S, Taniguchi T, O M, Dinter C, Lotz J, Eilers B, Wissmann C, Lott R, Meili MM, Schuetz PS, Hawa H, Sharshir M, Aburageila M, Salahuddin N, Chantziara V, Georgiou S, Tsimogianni A, Alexandropoulos P, Vassi A, Lagiou F, Valta M, Micha G, Chinou E, Michaloudis G, Kodaira A, Ikeda T, Ono S, Ueno T, Suda S, Izutani Y, Imaizumi H, De la Torre-Prados MV, Garcia-De la Torre A, Enguix-Armada A, Puerto-Morlan A, Perez-Valero V, Garcia-Alcantara A, Bolton N, Dudziak J, Bonney S, Tridente A, Nee P, Nicolaes G, Wiewel M, Schultz M, Wildhagen K, Horn J, Schrijver R, Van der Poll T, Reutelingsperger C, Pillai S, Davies G, Mills G, Aubrey R, Morris K, Williams P, Evans P, Gayat EG, Struck J, Cariou A, Deye N, Guidet B, Jabert S, Launay J, Legrand M, Léone M, Resche-Rigon M, Vicaut E, Vieillard-Baron A, Mebazaa A, Arnold R, Capan M, Linder A, Akesson P, Popescu M, Tomescu D, Sprung CL, Calderon Morales R, Munteanu G, Orenbuch-Harroch E, Levin P, Kasdan H, Reiter A, Volker T, Himmel Y, Cohen Y, Meissonnier J, Girard L, Rebeaud F, Herrmann I, Delwarde B, Peronnet E, Cerrato E, Venet F, Lepape A, Rimmelé T, Monneret G, Textoris J, Beloborodova N, Moroz V, Osipov A, Bedova A, Sarshor Y, Pautova A, Sergeev A, Chernevskaya E, Odermatt J, Bolliger R, Hersberger L, Ottiger M, Christ-Crain M, Mueller B, Schuetz P, Sharma NK, Tashima AK, Brunialti MK, Machado FR, Assuncao M, Rigato O, Salomao R, Cajander SC, Rasmussen G, Tina E, Söderquist B, Källman J, Strålin K, Lange AL, Sundén-Cullberg JS, Magnuson AM, Hultgren OH, Davies G, Pillai S, Mills G, Aubrey R, Morris K, Williams P, Evans P, Pillai S, Davies G, Mills G, Aubrey R, Morris K, Williams P, Evans P, Pillai S, Davies G, Mills G, Aubrey R, Morris K, Williams P, Evans P, Van der Geest P, Mohseni M, Linssen J, De Jonge R, Duran S, Groeneveld J, Miller R, Lopansri BK, McHugh LC, Seldon A, Burke JP, Johnston J, Reece-Anthony R, Bond A, Molokhia A, Mcgrath C, Nsutebu E, Bank Pedersen P, Pilsgaard Henriksen D, Mikkelsen S, Touborg Lassen A, Tincu R, Cobilinschi C, Tomescu D, Ghiorghiu Z, Macovei R, Wiewel MA, Harmon MB, Van Vught LA, Scicluna BP, Hoogendijk AJ, Horn J, Zwinderman AH, Cremer OL, Bonten MJ, Schultz MJ, Van der Poll T, Juffermans NP, Wiersinga WJ, Eren G, Tekdos Y, Dogan M, Acicbe O, Kaya E, Hergunsel O, Alsolamy S, Ghamdi G, Alswaidan L, Alharbi S, Alenezi F, Arabi Y, Heaton J, Boyce A, Nolan L, Johnston J, Dukoff-Gordon A, Dean A, Molokhia A, Mann Ben Yehudah T, Fleischmann C, Thomas-Rueddel D, Haas C, Dennler U, Reinhart K, Suntornlohanakul O, Khwannimit B, Breckenridge F, Puxty A, Szturz P, Folwarzcny P, Svancara J, Kula R, Sevcik P, Caneva L, Casazza A, Bellazzi E, Marra S, Pagani L, Vetere M, Vanzino R, Ciprandi D, Preda R, Boschi R, Carnevale L, Lopez V, Aguilar Arzapalo M, Barradas L, Escalante A, Gongora J, Cetina M, Adamik B, Jakubczyk D, Kübler A, Radford A, Lee T, Singer J, Boyd J, Fineberg D, Williams M, Russell J, Scarlatescu E, Tomescu D, Droc G, Arama S, Müller M, Straat M, Zeerleder SS, Juffermans NP, Fuchs CF, Scheer CS, Wauschkuhn SW, Vollmer MV, Meissner KM, Kuhn SK, Hahnenkamp KH, Rehberg SR, Gründling MG, Yamamoto N, Ojima M, Hamaguchi S, Hirose T, Akeda Y, Takegawa R, Tasaki O, Shimazu T, Tomono K, Gómez-Sánchez E, Heredia-Rodríguez M, Álvarez-Fuente E, Lorenzo-López M, Gómez-Pesquera E, Aragón-Camino M, Liu-Zhu P, Sánchez-López A, Hernández-Lozano A, Peláez-Jareño MT, Tamayo E, Thomas-Rüddel DO, Fleischmann C, Haas C, Dennler U, Reinhart K, Adora V, Kar A, Chakraborty A, Roy S, Bandyopadhyay A, Das M, Mann Ben Yehudah T, BenYehudah G, Salim M, Kumar N, Arabi L, Burger T, Lephart P, Toth-martin E, Valencia C, Hammami N, Blot S, Vincent JL, Lambert ML, Brunke J, Riemann T, Roschke I, Tincu R, Cobilinschi C, Tomescu D, Ghiorghiu Z, Macovei R, Nimitvilai S, Jintanapramote K, Jarupongprapa S, Adukauskiene D, Valanciene D, Bose G, Lostarakos V, Carr B, Khedher S, Maaoui A, Ezzamouri A, Salem M, Chen J, Cranendonk DR, Van Vught LA, Wiewel MA, Cremer OL, Horn J, Bonten MJ, Schultz MJ, Van der Poll T, Wiersinga WJ, Day M, Penrice G, Roy K, Robertson P, Godbole G, Jones B, Booth M, Donaldson L, Kawano Y, Ishikura H, Al-Dorzi H, Almutairi M, Alhamadi B, Crizaldo Toledo A, Khan R, Al Raiy B, Arabi Y, Talaie H, Van Oers JA, Harts A, Nieuwkoop E, Vos P, Boussarsar Y, Boutouta F, Kamoun S, Mezghani I, Koubaji S, Ben Souissi A, Riahi A, Mebazaa MS, Giamarellos-Bourboulis E, Tziolos N, Routsi C, Katsenos C, Tsangaris I, Pneumatikos I, Vlachogiannis G, Theodorou V, Prekates A, Antypa E, Koulouras V, Kapravelos N, Gogos C, Antoniadou E, Mandragos K, Armaganidis A, Robles Caballero AR, Civantos B, Figueira JC, López J, Silva-Pinto A, Ceia F, Sarmento A, Santos L, Almekhlafi G, Sakr Y, Al-Dorzi H, Khan R, Baharoon S, Aldawood A, Matroud A, Alchin J, Al Johani S, Balkhy H, Arabi Y, Alsolamy S, Yousif SY, Alotabi BO, Alsaawi AS, Ang J, Curran MD, Enoch D, Navapurkar V, Morris A, Sharvill R, Astin J, Heredia-Rodríguez M, Gómez-Sánchez E, Peláez-Jareño MT, Gómez-Pesquera E, Lorenzo-López M, Liu-Zhu P, Aragón-Camino M, Hernández-Lozano A, Sánchez-López A, Álvarez-Fuente E, Tamayo E, Patel J, Kruger C, O’Neal J, Rhodes H, Jancik J, François B, Laterre PF, Eggimann P, Torres A, Sánchez M, Dequin PF, Bassi GL, Chastre J, Jafri HS, Ben Romdhane M, Douira Z, Kamoun S, Bousselmi M, Ben Souissi A, Boussarsar Y, Riahi A, Mebazaa MS, Vakalos A, Avramidis V, Craven TH, Wojcik G, Kefala K, McCoubrey J, Reilly J, Paterson R, Inverarity D, Laurenson I, Walsh TS, Mongodi S, Bouhemad B, Orlando A, Stella A, Via G, Iotti G, Braschi A, Mojoli F, Haliloglu M, Bilgili B, Kasapoglu U, Sayan I, Süzer Aslan M, Yalcın A, Cinel I, Vakalos A, Avramidis V, Ellis HE, Bauchmuller K, Miller D, Temple A, Chastre J, François B, Torres A, Luyt CE, Sánchez M, Singer M, Jafri HS, Nassar Y, Ayad MS, Trifi A, Abdellatif S, Daly F, Nasri R, Ben Lakhal S, Bilgili B, Haliloglu M, Gul F, Cinel I, Kuzovlev A, Shabanov A, Polovnikov S, Moroz V, Kadrichu N, Dang T, Corkery K, Challoner P, Bassi GL, Aguilera E, Chiurazzi C, Travierso C, Motos A, Fernandez L, Amaro R, Senussi T, Idone F, Bobi J, Rigol M, Torres A, Hodiamont CJ, Juffermans NP, Janssen JM, Bouman CS, Mathôt RA, De Jong MD, Van Hest RM, Payne L, Fraser GL, Tudor B, Lahner M, Roth G, Krenn C, Talaie H, Jault P, Gabard J, Leclerc T, Jennes S, Que Y, Rousseau A, Ravat F, Al-Dorzi H, Eissa A, Al-Harbi S, Aldabbagh T, Khan R, Arabi Y, Trifi A, Abdellatif. S, Daly F, Nasri R, Ben Lakhal S, Paramba F, Purayil N, Naushad V, Mohammad O, Negi V, Chandra P, Kleinsasser A, Witrz MR, Buchner-Doeven JF, Tuip-de Boer AM, Goslings JC, Juffermans NP, Van Hezel M, Straat M, Boing A, Van Bruggen R, Juffermans N, Markopoulou D, Venetsanou K, Kaldis V, Koutete D, Chroni D, Alamanos I, Koch L, Jancik J, Rhodes H, Walter E, Maekawa K, Hayakawa M, Kushimoto S, Shiraishi A, Kato H, Sasaki J, Ogura H, Matauoka T, Uejima T, Morimura N, Ishikura H, Hagiwara A, Takeda M, Tarabrin O, Shcherbakow S, Gavrychenko D, Mazurenko G, Ivanova V, Chystikov O, Plourde C, Lessard J, Chauny J, Daoust R, Shcherbakow S, Tarabrin O, Gavrychenko D, Mazurenko G, Chystikov O, Vakalos A, Avramidis V, Kropman L, In het Panhuis L, Konings J, Huskens D, Schurgers E, Roest M, De Laat B, Lance M, Durila M, Lukas P, Astraverkhava M, Jonas J, Budnik I, Shenkman B, Hayami H, Koide Y, Goto T, Iqbal R, Alhamdi Y, Venugopal N, Abrams S, Downey C, Toh CH, Welters ID, Bombay VB, Chauny JM, Daoust RD, Lessard JL, Marquis MM, Paquet JP, Siemens K, Sangaran D, Hunt BJ, Durward A, Nyman A, Murdoch IA, Tibby SM, Ampatzidou F, Moisidou D, Dalampini E, Nastou M, Vasilarou E, Kalaizi V, Chatzikostenoglou H, Drossos G, Spadaro S, Fogagnolo A, Fiore T, Schiavi A, Fontana V, Taccone F, Volta C, Chochliourou E, Volakli E, Violaki A, Samkinidou E, Evlavis G, Panagiotidou V, Sdougka M, Mothukuri R, Battle C, Guy K, Mills G, Evans P, Wijesuriya J, Keogh S, Docherty A, O’Donnell R, Brunskill S, Trivella M, Doree C, Holst L, Parker M, Gregersen M, Almeida J, Walsh T, Stanworth S, Moravcova S, Mansell J, Rogers A, Smith RA, Hamilton-Davies C, Omar A, Allam M, Bilala O, Kindawi A, Ewila H, Ampatzidou F, Moisidou D, Nastou M, Dalampini E, Malamas A, Vasilarou E, Drossos G, Ferreira G, Caldas J, Fukushima J, Osawa EA, Arita E, Camara L, Zeferino S, Jardim J, Gaioto F, Dallan L, Jatene FB, Kalil Filho R, Galas F, Hajjar LA, Mitaka C, Ohnuma T, Murayama T, Kunimoto F, Nagashima M, Takei T, Tomita M, Omar A, Mahmoud K, Hanoura S, Sudarsanan S, Sivadasan P, Othamn H, Shouman Y, Singh R, Al Khulaifi A, Mandel I, Mikheev S, Suhodolo I, Kiselev V, Svirko Y, Podoksenov Y, Jenkins SA, Griffin R, Tovar Doncel MS, Lima A, Aldecoa C, Ince C, Taha A, Shafie A, Mostafa M, Syed N, Hon H, Righetti F, Colombaroli E, Castellano G, Righetti F, Colombaroli E, Hravnak M, Chen LC, Dubrawski AD, Clermont GC, Pinsky MR, Gonzalez S, Macias D, Acosta J, Jimenez P, Loza A, Lesmes A, Lucena F, Leon C, Tovar Doncel MS, Ince C, Aldecoa C, Lima A, Bastide M, Richecoeur J, Frenoy E, Lemaire C, Sauneuf B, Tamion F, Nseir S, Du Cheyron D, Dupont H, Maizel J, Shaban M, Kolko R, Salahuddin N, Sharshir M, AbuRageila M, AlHussain A, Mercado P, Maizel J, Kontar L, Titeca D, Brazier F, Riviere A, Joris M, Soupison T, De Cagny B, Slama M, Wagner J, Körner A, Kubik M, Kluge S, Reuter D, Saugel B, Colombaroli E, Righetti F, Castellano G, Tran T, De Bels D, Cudia A, Strachinaru M, Ghottignies P, Devriendt J, Pierrakos C, Martínez González Ó, Blancas R, Luján J, Ballesteros D, Martínez Díaz C, Núñez A, Martín Parra C, López Matamala B, Alonso Fernández M, Chana M, Huber W, Eckmann M, Elkmann F, Gruber A, Klein I, Schmid RM, Lahmer T, Moller PW, Sondergaard S, Jakob SM, Takala J, Berger D, Bastoni D, Aya H, Toscani L, Pigozzi L, Rhodes A, Cecconi M, Ostrowska C, Aya H, Abbas A, Mellinghoff J, Ryan C, Dawson D, Rhodes A, Cecconi M, Cronhjort M, Wall O, Nyberg E, Zeng R, Svensen C, Mårtensson J, Joelsson-Alm E, Aguilar Arzapalo M, Barradas L, Lopez V, Cetina M, Parenti N, Palazzi C, Amidei LA, Borrelli FB, Campanale SC, Tagliazucchi FT, Sedoni GS, Lucchesi DL, Carella EC, Luciani AL, Mackovic M, Maric N, Bakula M, Aya H, Rhodes A, Grounds RM, Fletcher N, Cecconi M, Avard B, Zhang P, Mezidi M, Charbit J, Ould-Chikh M, Deras P, Maury C, Martinez O, Capdevila X, Hou P, Linde-Zwirble WZ, Douglas ID, Shapiro NS, Ben Souissi A, Mezghani I, Ben Aicha Y, Kamoun S, Laribi B, Jeribi B, Riahi A, Mebazaa MS, Pereira C, Marinho R, Antunes R, Marinho A, Crivits M, Raes M, Decruyenaere J, Hoste E, Bagin V, Rudnov V, Savitsky A, Astafyeva M, Korobko I, Vein V, Kampmeier T, Arnemann P, Hessler M, Wald A, Bockbreder K, Morelli A, Van Aken H, Rehberg S, Ertmer C, Arnemann P, Hessler M, Kampmeier T, Rehberg S, Van Aken H, Ince C, Ertmer C, Reddy S, Bailey M, Beasley R, Bellomo R, Mackle D, Psirides A, Young P, Reddy S, Bailey M, Beasley R, Bellomo R, Mackle D, Young P, Venkatesh H, Ramachandran S, Basu A, Nair H, Egan S, Bates J, Oliveira S, Rangel Neto NR, Reis FQ, Lee CP, Lin XL, Choong C, Eu KM, Sim WY, Tee KS, Pau J, Abisheganaden J, Maas K, De Geus H, Lafuente E, Marinho R, Moura J, Antunes R, Marinho A, Doris TE, Monkhouse D, Shipley T, Kardasz S, Gonzalez I, Stads S, Groeneveld AJ, Elsayed I, Ward N, Tridente A, Raithatha A, Steuber A, Pelletier C, Schroeder S, Michael E, Slowinski T, Kindgen-Milles D, Ghabina S, Turani F, Belli A, Busatti S, Barettin G, Candidi F, Gargano F, Barchetta R, Falco M, Demirkiran O, Kosuk M, Bozbay S, Weber V, Hartmann J, Harm S, Linsberger I, Eichhorn T, Valicek G, Miestinger G, Hoermann C, Faenza S, Ricci D, Mancini E, Gemelli C, Cuoghi A, Magnani S, Atti M, Laddomada T, Doronzio A, Balicco B, Gruda MC, O’Sullivan P, Dan VP, Guliashvili T, Scheirer A, Golobish TD, Capponi VJ, Chan PP, Kogelmann K, Drüner M, Jarczak D, Turani F, Belli AB, Martni SM, Cotticelli VC, Mounajergi F, Barchetta R, Morimoto S, Ishikura H, Hussain I, Salahuddin N, Nadeem A, Ghorab K, Maghrabi K, Kloesel SK, Goldfuss C, Stieglitz A, Stieglitz AS, Krstevska L, Albuszies G, Aguilar Arzapalo M, Barradas L, Lopez V, Escalante A, Jimmy G, Cetina M, Izawa J, Iwami T, Uchino S, Takinami M, Kitamura T, Kawamura T, Powell-Tuck JG, Crichton S, Raimundo M, Camporota L, Wyncoll D, Ostermann M, Hana A, De Geus HR, De Geus HR, Hana A, Aydogdu M, Boyaci N, Yuksel S, Gursel G, Cayci Sivri AB, Meza-Márquez J, Nava-López J, Carrillo-Esper R, Dardashti A, Grubb A, Maizel J, Wetzstein M, Titeca D, Kontar L, Brazier F, De Cagny B, Riviere A, Soupison T, Joris M, Slama M, Peters E, Njimi H, Pickkers P, Vincent JL, Waraich M, Doyle J, Samuels T, Forni L, Desai N, Baumber R, Gunning P, Sell A, Lin S, Torrence H, O’Dwyer M, Kirwan C, Prowle J, Kim T, O’Connor ME, Hewson RW, Kirwan CJ, Pearse RM, Prowle J, Hanoura S, Omar A, Othamn H, Sudarsanan S, Allam M, Maksoud M, Singh R, Al Khulaifi A, O’Connor ME, Hewson RW, Kirwan CJ, Pearse RM, Prowle J, Uzundere O, Memis D, Ýnal M, Gultekin A, Turan N, Aydin MA, Basar H, Sencan I, Kapuagasi A, Ozturk M, Uzundurukan Z, Gokmen D, Ozcan A, Kaymak C, Artemenko VA, Budnyuk A, Pugh R, Bhandari S, Mauri T, Turrini C, Langer T, Taccone P, Volta CA, Marenghi C, Gattinoni L, Pesenti A, Sweeney L, O’Sullivan A, Kelly P, Mukeria E, MacLoughlin R, Pfeffer M, Thomas JT, Bregman GB, Karp GK, Kishinevsky EK, Stavi DS, Adi NA, Poropat T, Knafelj R, Llopart E, Batlle M, De Haro C, Mesquida J, Artigas A, Pavlovic D, Lewerentz L, Spassov A, Schneider R, De Smet S, De Raedt S, Derom E, Depuydt P, Oeyen S, Benoit D, Decruyenaere J, Gobatto A, Besen B, Tierno P, Melro L, Mendes P, Cadamuro F, Park M, Malbouisson LM, Civantos BC, Lopez JL, Robles A, Figueira J, Yus S, Garcia A, Oglinda A, Ciobanu G, Oglinda C, Schirca L, Sertinean T, Lupu V, Kelly P, O’Sullivan A, Sweeney L, MacLoughlin R, O’Sullivan A, Kelly P, Sweeney L, Mukeria E, Wolny M, MacLoughlin R, Pagano A, Numis F, Visone G, Saldamarco L, Russo T, Porta G, Paladino F, Bell C, Liu J, Debacker J, Lee C, Tamberg E, Campbell V, Mehta S, Silva-Pinto A, Sarmento A, Santos L, Kara Ý, Yýldýrým F, Zerman A, Güllü Z, Boyacý N, Basarýk Aydogan B, Gaygýsýz Ü, Gönderen K, Arýk G, Turkoglu M, Aydogdu M, Aygencel G, Ülger Z, Gursel G, Boyacý N, Isýkdogan Z, Özdedeoglu Ö, Güllü Z, Badoglu M, Gaygýsýz U, Aydogdu M, Gursel G, Kongpolprom N, Sittipunt C, Eden A, Kokhanovsky Y, Bursztein – De Myttenaere S, Pizov R, Neilans L, MacIntyre N, Radosevich M, Wanta B, Weber V, Meyer T, Smischney N, Brown D, Diedrich D, Fuller A, McLindon P, Sim K, Shoaeir M, Noeam K, Mahrous A, Matsa R, Ali A, Dridi C, Koubaji S, Kamoun S, Haddad F, Ben Souissi A, Laribi B, Riahi A, Mebazaa MS, Pérez-Calatayud A, Carrillo-Esper R, Zepeda-Mendoza A, Diaz-Carrillo M, Arch-Tirado E, Carbognin S, Pelacani L, Zannoni F, Agnoli A, Gagliardi G, Cho R, Adams A, Lunos S, Ambur S, Shapiro R, Prekker M, Thijssen M, Janssen L, Foudraine N, Voscopoulos CJ, Freeman J, Voscopoulos CJ, Freeman J, George E, Voscopoulos CJ, Eversole D, Freeman J, George E, Muttini S, Bigi R, Villani G, Patroniti N, Williams G, Voscopoulos CJ, Freeman J, George E, Waldmann A, Böhm S, Windisch W, Strassmann S, Karagiannidis C, Waldmann A, Böhm S, Windisch W, Strassmann S, Karagiannidis C, Karagiannidis CK, Waldmann AW, Böhm SB, Strassmann S, Windisch WW, Persson P, Lundin S, Stenqvist O, Porta G, Numis F, Serra CS, Pagano AP, Masarone MM, Rinaldi LR, Amelia AA, Fascione MF, Adinolfi LA, Ruggiero ER, Asota F, O’Rourke K, Ranjan S, Morgan P, DeBacker JW, Tamberg E, O’Neill L, Munshi L, Burry L, Fan E, Mehta S, Poo S, Mahendran K, Fowles J, Gerrard C, Vuylsteke A, Loveridge R, Chaddock C, Patel S, Kakar V, Willars C, Hurst T, Park C, Best T, Vercueil A, Auzinger G, Borgman A, Proudfoot AG, Grins E, Emiley KE, Schuitema J, Fitch SJ, Marco G, Sturgill J, Dickinson MG, Strueber M, Khaghani A, Wilton P, Jovinge SM, Sampson C, Harris-Fox S, Cove ME, Vu LH, Sen A, Federspiel WJ, Kellum JA, Mazo Torre C, Riera J, Ramirez S, Borgatta B, Lagunes L, Rello J, Kuzovlev AK, Moroz V, Goloubev A, Polovnikov S, Nenchuk S, Karavana V, Glynos C, Asimakos A, Pappas K, Vrettou C, Magkou M, Ischaki E, Stathopoulos G, Zakynthinos S, Spadaro S, Kozhevnikova I, Dalla Corte F, Grasso S, Casolari P, Caramori G, Volta C, Andrianjafiarinoa T, Randriamandrato T, Rajaonera T, El-Dash S, Costa ELV, Tucci MR, Leleu F, Kontar L, De Cagny B, Brazier F, Titeca D, Bacari-Risal G, Maizel J, Amato M, Slama M, Mercado P, Maizel J, Kontar L, Titeca D, Brazier F, Riviere A, Joris M, Soupison T, De Cagny B, El Dash S, Slama M, Remmington, Fischer A, Squire S, Boichat M, Honzawa H, Yasuda H, Adati T, Suzaki S, Horibe M, Sasaki M, Sanui M, Marinho R, Daniel J, Miranda H, Marinho A, Milinis K, Cooper M, Williams GR, McCarron E, Simants S, Patanwala I, Welters I, Su Y, Fernández Villanueva J, Fernández Garda R, López Lago A, Rodríguez Ruíz E, Hernández Vaquero R, Tomé Martínez de Rituerto S, Varo Pérez E, Lefel N, Schaap F, Bergmans D, Olde Damink S, Van de Poll M, Tizard K, Lister C, Poole L, Ringaitiene D, Gineityte D, Vicka V, Norkiene I, Sipylaite J, O’Loughlin A, Maraj V, Dowling J, Velasco MB, Dalcomune DM, Dias EB, Fernandes SL, Oshima T, Graf S, Heidegger C, Genton L, Karsegard V, Dupertuis Y, Pichard C, Friedli N, Stanga Z, Mueller B, Schuetz P, Vandersteen L, Stessel B, Evers S, Van Assche A, Jamaer L, Dubois J, Marinho R, Castro H, Moura J, Valente J, Martins P, Casteloes P, Magalhaes C, Cabral S, Santos M, Oliveira B, Salgueiro A, Marinho A, Marinho R, Santos M, Lafuente E, Castro H, Cabral S, Moura J, Martins P, Oliveira B, Salgueiro A, Duarte S, Castro S, Melo M, Casteloes P, Marinho A, Gray S, Maipang K, Bhurayanontachai R, Grädel LG, Schütz P, Langlois P, Manzanares W, Tincu R, Cobilinschi C, Tomescu D, Ghiorghiu Z, Macovei R, Manzanares W, Langlois P, Lemieux M, Elke G, Bloos F, Reinhart K, Heyland D, Langlois P, Lemieux M, Aramendi I, Heyland D, Manzanares W, Su Y, Marinho R, Babo N, Marinho A, Hoshino M, Haraguchi Y, Kajiwara S, Mitsuhashi T, Tsubata T, Aida M, Rattanapraphat T, Bhurayanontachai R, Kongkamol C, Khwannimit B, Marinho R, Santos M, Castro H, Lafuente E, Salgueiro A, Cabral S, Martins P, Moura J, Oliveira B, Melo M, Xavier B, Valente J, Magalhaes C, Casteloes P, Marinho A, Moisidou D, Ampatzidou F, Koutsogiannidis C, Moschopoulou M, Drossos G, Taskin G, Çakir M, Güler AK, Taskin A, Öcal N, Özer S, Yamanel L, Wong JM, Fitton C, Anwar S, Stacey S, Aggou M, Fyntanidou B, Patsatzakis S, Oloktsidou E, Lolakos K, Papapostolou E, Grosomanidis V, Suda S, Ikeda T, Ono S, Ueno T, Izutani Y, Gaudry S, Desailly V, Pasquier P, Brun PB, Tesnieres AT, Ricard JD, Dreyfuss D, Mignon A, White JC, Molokhia A, Dean A, Stilwell A, Friedlaender G, Peters M, Stipulante S, Delfosse A, Donneau AF, Ghuysen A, Feldmann C, Freitag D, Dersch W, Irqsusi M, Eschbach D, Steinfeldt T, Wulf H, Wiesmann T, Kongpolprom N, Cholkraisuwat J, Beitland S, Nakstad E, Stær-Jensen H, Drægni T, Andersen G, Jacobsen D, Brunborg C, Waldum-Grevbo B, Sunde K, Hoyland K, Pandit D, Hayakawa K, Oloktsidou E, Kotzampassi K, Fyntanidou B, Patsatzakis S, Loukipoudi L, Doumaki E, Grosomanidis V, Yasuda H, Admiraal MM, Van Assen M, Van Putten MJ, Tjepkema-Cloostermans M, Van Rootselaar AF, Horn J, Ragusa F, Marudi A, Baroni S, Gaspari A, Bertellini E, Taha A, Abdullah T, Abdel Monem S, Alcorn S, McNeill S, Russell S, Eertmans W, Genbrugge C, Meex I, Dens J, Jans F, De Deyne C, Cholkraisuwat J, Kongpolprom N, Avard B, Burns R, Patarchi A, Spina T, Tanaka H, Otani N, Ode S, Ishimatsu S, Cho J, Moon JB, Park CW, Ohk TG, Shin MC, Won MH, Dakova S, Ramsheva Z, Ramshev K, Cho J, Moon JB, Park CW, Ohk TG, Shin MC, Cho J, Moon JB, Park CW, Ohk TG, Shin MC, Marudi A, Baroni S, Gaspari A, Bertellini E, Orhun G, Senturk E, Ozcan PE, Sencer S, Ulusoy C, Tuzun E, Esen F, Tincu R, Cobilinschi C, Tomescu D, Ghiorghiu Z, Macovei R, Van Assen M, Admiraal MM, Van Putten MJ, Tjepkema-Cloostermans M, Van Rootselaar AF, Horn J, Fallenius M, Skrifvars MB, Reinikainen M, Bendel S, Raj R, Abu-Habsa M, Hymers C, Borowska A, Sivadhas H, Sahiba S, Perkins S, Rubio J, Rubio JA, Sierra R, English S, Chasse M, Turgeon A, Lauzier F, Griesdale D, Garland A, Fergusson D, Zarychanski R, Tinmouth A, Van Walraven C, Montroy K, Ziegler J, Dupont Chouinard R, Carignan R, Dhaliwal A, Lum C, Sinclair J, Pagliarello G, McIntyre L, English S, Chasse M, Turgeon A, Lauzier F, Griesdale D, Garland A, Fergusson D, Zarychanski R, Tinmouth A, Van Walraven C, Montroy K, Ziegler J, Dupont Chouinard R, Carignan R, Dhaliwal A, Lum C, Sinclair J, Pagliarello G, McIntyre L, Groza T, Moreau N, Castanares-Zapatero D, Hantson P, Carbonara M, Ortolano F, Zoerle T, Magnoni S, Pifferi S, Conte V, Stocchetti N, Carteron L, Suys T, Patet C, Quintard H, Oddo M, Rubio JA, Rubio J, Sierra R, Spatenkova V, Pokorna E, Suchomel P, Ebert N, Jancik J, Rhodes H, Bylinski T, Hawthorne C, Shaw M, Piper I, Kinsella J, Kink AK, Rätsep IR, Boutin A, Moore L, Chasse M, Zarychanski R, Lauzier F, English S, McIntyre L, Lacroix J, Griesdale D, Lessard-Bonaventure P, Turgeon AF, Boutin A, Moore L, Green R, Lessard-Bonaventure P, Erdogan M, Butler M, Lauzier F, Chasse M, English S, McIntyre L, Zarychanski R, Lacroix J, Griesdale D, Desjardins P, Fergusson DA, Turgeon AF, Goncalves B, Vidal B, Valdez C, Rodrigues AC, Miguez L, Moralez G, Hong T, Kutz A, Hausfater P, Amin D, Struja T, Haubitz S, Huber A, Mueller B, Schuetz P, Brown T, Collinson J, Pritchett C, Slade T, Le Guen M, Hellings S, Ramsaran R, Alsheikhly A, Abe T, Kanapeckaite L, Abu-Habsa M, Bahl R, Russell MQ, Real KJ, Abu-Habsa M, Lyon RM, Oveland NP, Penketh J, Mcdonald M, Kelly F, Alfafi M, Alsolamy S, Almutairi W, Alotaibi B, Van den Berg AE, Schriel Y, Dawson L, Meynaar IA, Talaie H, Silva D, Fernandes S, Gouveia J, Santos Silva J, Foley J, Kaskovagheorgescu A, Evoy D, Cronin J, Ryan J, Huck M, Hoffmann C, Renner J, Laitselart P, Donat N, Cirodde A, Schaal JV, Masson Y, Nau A, Leclerc T, Howarth O, Davenport K, Jeanrenaud P, Raftery S, MacTavish P, Devine H, McPeake J, Daniel M, Kinsella J, Quasim T, Alrabiee S, Alrashid A, Alsolamy S, Gundogan O, Bor C, Akýn Korhan E, Demirag K, Uyar M, Frame F, Ashton C, Bergstrom Niska L, Dilokpattanamongkol P, Suansanae T, Suthisisang C, Morakul S, Karnjanarachata C, Tangsujaritvijit V, Mahmood S, Al Thani H, Almenyar A, Vakalos A, Avramidis V, Sharvill R, Penketh J, Morton SE, Chiew YS, Pretty C, Chase JG, Shaw GM, Knafelj R, Kordis P, Patel S, Grover V, Kuchyn I, Bielka K, Aidoni Z, Grosomanidis V, Kotzampassi K, Stavrou G, Fyntanidou B, Patsatzakis S, Skourtis C, Lee SD, Williams K, Weltes ID, Berhane S, Arrowsmith C, Peters C, Robert S, Caldas J, Panerai RB, Robinson TG, Camara L, Ferreira G, Borg-Seng-Shu E, De Lima Oliveira M, Mian NC, Santos L, Nogueira R, Zeferino SP, Jacobsen Teixeira M, Galas F, Hajjar LA, Killeen P, McPhail M, Bernal W, Maggs J, Wendon J, Hughes T, Taniguchi LU, Siqueira EM, Vieira Jr JM, Azevedo LC, Ahmad AN, Abu-Habsa M, Bahl R, Helme E, Hadfield S, Loveridge R, Shak J, Senver C, Howard-Griffin R, Wacharasint P, Fuengfoo P, Sukcharoen N, Rangsin R, Sbiti-Rohr D, Schuetz P, Na H, Song S, Lee S, Jeong E, Lee K, Cooper M, Milinis K, Williams G, McCarron E, Simants S, Patanwala I, Welters ID, Zoumpelouli E, Volakli EA, Chrysohoidou V, Georgiou S, Charisopoulou K, Kotzapanagiotou E, Panagiotidou V, Manavidou K, Stathi Z, Sdougka M, Salahuddin N, AlGhamdi B, Marashly Q, Zaza K, Sharshir M, Khurshid M, Ali Z, Malgapo M, Jamil M, Shafquat A, Shoukri M, Hijazi M, Abe T, Uchino S, Takinami M, Rangel Neto NR, Oliveira S, Reis FQ, Rocha FA, Moralez G, Ebecken K, Rabello LS, Lima MF, Hatum R, De Marco FV, Alves A, Pinto JE, Godoy M, Brasil PE, Bozza FA, Salluh JI, Soares M, Krinsley J, Kang G, Perry J, Hines H, Wilkinson KM, Tordoff C, Sloan B, Bellamy MC, Moreira E, Verga F, Barbato M, Burghi G, Soares M, Silva UV, Azevedo LC, Torelly AP, Kahn JM, Angus DC, Knibel MF, Brasil PE, Bozza FA, Salluh JI, Velasco MB, Dalcomune DM, Marshall R, Gilpin T, Tridente A, Raithatha A, Mota D, Loureiro B, Dias J, Afonso O, Coelho F, Martins A, Faria F, Al-Dorzi H, Al Orainni H, AlEid F, Tlaygeh H, Itani A, Hejazi A, Arabi Y, Gaudry S, Messika J, Ricard JD, Guillo S, Pasquet B, Dubief E, Dreyfuss D, Tubach F, Battle C, James K, Temblett P, Davies L, Battle C, Lynch C, Pereira S, Cavaco S, Fernandes J, Moreira I, Almeida E, Seabra Pereira F, Malheiro M, Cardoso F, Aragão I, Cardoso T, Fister M, Knafelj R, Muraray Govind P, Brahmananda Reddy N, Pratheema R, Arul ED, Devachandran J, Velasco MB, Dalcomune DM, Knafelj R, Fister M, Chin-Yee N, D’Egidio G, Thavorn K, Heyland D, Kyeremanteng K, Murchison AG, Swalwell K, Mandeville J, Stott D, Guerreiro I, Devine H, MacTavish P, McPeake J, Quasim T, Kinsella J, Daniel M, Goossens C, Marques MB, Derde S, Vander Perre S, Dufour T, Thiessen SE, Güiza F, Janssens T, Hermans G, Vanhorebeek I, De Bock K, Van den Berghe G, Langouche L, Devine H, MacTavish P, Quasim T, Kinsella J, Daniel M, McPeake J, Miles B, Madden S, Devine H, Weiler M, Marques P, Rodrigues C, Boeira M, Brenner K, Leães C, Machado A, Townsend R, Andrade J, MacTavish P, McPeake J, Devine H, Kinsella J, Daniel M, Kishore R, Fenlon C, Quasim T, Fiks T, Ruijter A, Te Raa M, Spronk P, Chiew YS, Docherty P, Dickson J, Moltchanova E, Scarrot C, Pretty C, Shaw GM, Chase JG, Hall T, Ngu WC, Jack JM, Morgan P, Avard B, Pavli A, Gee X, Bor C, Akin Korhan E, Demirag K, Uyar M, Shirazy M, Fayed A, Gupta S, Kaushal A, Dewan S, Varma A, Ghosh E, Yang L, Eshelman L, Lord B, Carlson E, Helme E, Broderick R, Hadfield S, Loveridge R, Ramos J, Forte D, Yang F, Hou P, Dudziak J, Feeney J, Wilkinson K, Bauchmuller K, Shuker K, Faulds M, Raithatha A, Bryden D, England L, Bolton N, Tridente A, Bauchmuller K, Shuker K, Tridente A, Faulds M, Matheson A, Gaynor J, Bryden D, S South Yorkshire Hospitals Research Collaboration. Ramos J, Peroni B, Daglius-Dias R, Miranda L, Cohen C, Carvalho C, Velasco I, Forte D, Kelly JM, Neill A, Rubenfeld G, Masson N, Min A, Boezeman E, Hofhuis J, Hovingh A, De Vries R, Spronk P, Cabral-Campello G, Aragão I, Cardoso T, Van Mol M, Nijkamp M, Kompanje E, Ostrowski P, Omar A, Kiss K, Köves B, Csernus V, Molnár Z, Hoydonckx Y, Vanwing S, Stessel B, Van Assche A, Jamaer L, Dubois J, Medo V, Galvez R, Miranda JP, Stone C, Wigmore T, Arunan Y, Wheeler A, Bauchmuller K, Bryden D, Wong Y, Poi C, Gu C, Molmy P, Van Grunderbeeck N, Nigeon O, Lemyze M, Thevenin D, Mallat J, Ramos J, Correa M, Carvalho RT, Forte D, Fernandez A, McBride C, Koonthalloor E, Walsh C, Webber A, Ashe M, Smith K, Jeanrenaud P, Marudi A, Baroni S, Ragusa F, Bertellini E, Volakli EA, Chochliourou E, Dimitriadou M, Violaki A, Mantzafleri P, Samkinidou E, Vrani O, Arbouti A, Varsami T, Sdougka M, Bollen JA, Van Smaalen TC, De Jongh WC, Ten Hoopen MM, Ysebaert D, Van Heurn LW, Van Mook WN, Sim K, Fuller A, Roze des Ordons A, Couillard P, Doig C, Van Keer RV, Deschepper RD, Francke AF, Huyghens LH, Bilsen JB, Nyamaizi B, Dalrymple C, Molokhia A, Dobru A, Marrinan E, Ankuli A, Molokhia A, McPeake J, Struthers R, Crawford R, Devine H, Mactavish P, Quasim T, Morelli P, Degiovanangelo M, Lemos F, MArtinez V, Verga F, Cabrera J, Burghi G, Rutten A, Van Ieperen S, De Geer S, Van Vugt M, Der Kinderen E, Giannini A, Miccinesi G, Marchesi T, Prandi E. 36th International Symposium on Intensive Care and Emergency Medicine : Brussels, Belgium. 15-18 March 2016. Crit Care. 2016 Apr 20;20(Suppl 2):94. [PMC free article: PMC5493079] [PubMed: 27885969]

Anoxic Encephalopathy – StatPearls – NCBI Bookshelf

Bateman RM, Sharpe MD, Jagger JE, Ellis CG, Solé-Violán J, López-Rodríguez M, Herrera-Ramos E, Ruíz-Hernández J, Borderías L, Horcajada J, González-Quevedo N, Rajas O, Briones M, Rodríguez de Castro F, Rodríguez Gallego C, Esen F, Orhun G, Ergin Ozcan P, Senturk E, Ugur Yilmaz C, Orhan N, Arican N, Kaya M, Kucukerden M, Giris M, Akcan U, Bilgic Gazioglu S, Tuzun E, Riff R, Naamani O, Douvdevani A, Takegawa R, Yoshida H, Hirose T, Yamamoto N, Hagiya H, Ojima M, Akeda Y, Tasaki O, Tomono K, Shimazu T, Ono S, Kubo T, Suda S, Ueno T, Ikeda T, Hirose T, Ogura H, Takahashi H, Ojima M, Kang J, Nakamura Y, Kojima T, Shimazu T, Ikeda T, Suda S, Izutani Y, Ueno T, Ono S, Taniguchi T, O M, Dinter C, Lotz J, Eilers B, Wissmann C, Lott R, Meili MM, Schuetz PS, Hawa H, Sharshir M, Aburageila M, Salahuddin N, Chantziara V, Georgiou S, Tsimogianni A, Alexandropoulos P, Vassi A, Lagiou F, Valta M, Micha G, Chinou E, Michaloudis G, Kodaira A, Ikeda T, Ono S, Ueno T, Suda S, Izutani Y, Imaizumi H, De la Torre-Prados MV, Garcia-De la Torre A, Enguix-Armada A, Puerto-Morlan A, Perez-Valero V, Garcia-Alcantara A, Bolton N, Dudziak J, Bonney S, Tridente A, Nee P, Nicolaes G, Wiewel M, Schultz M, Wildhagen K, Horn J, Schrijver R, Van der Poll T, Reutelingsperger C, Pillai S, Davies G, Mills G, Aubrey R, Morris K, Williams P, Evans P, Gayat EG, Struck J, Cariou A, Deye N, Guidet B, Jabert S, Launay J, Legrand M, Léone M, Resche-Rigon M, Vicaut E, Vieillard-Baron A, Mebazaa A, Arnold R, Capan M, Linder A, Akesson P, Popescu M, Tomescu D, Sprung CL, Calderon Morales R, Munteanu G, Orenbuch-Harroch E, Levin P, Kasdan H, Reiter A, Volker T, Himmel Y, Cohen Y, Meissonnier J, Girard L, Rebeaud F, Herrmann I, Delwarde B, Peronnet E, Cerrato E, Venet F, Lepape A, Rimmelé T, Monneret G, Textoris J, Beloborodova N, Moroz V, Osipov A, Bedova A, Sarshor Y, Pautova A, Sergeev A, Chernevskaya E, Odermatt J, Bolliger R, Hersberger L, Ottiger M, Christ-Crain M, Mueller B, Schuetz P, Sharma NK, Tashima AK, Brunialti MK, Machado FR, Assuncao M, Rigato O, Salomao R, Cajander SC, Rasmussen G, Tina E, Söderquist B, Källman J, Strålin K, Lange AL, Sundén-Cullberg JS, Magnuson AM, Hultgren OH, Davies G, Pillai S, Mills G, Aubrey R, Morris K, Williams P, Evans P, Pillai S, Davies G, Mills G, Aubrey R, Morris K, Williams P, Evans P, Pillai S, Davies G, Mills G, Aubrey R, Morris K, Williams P, Evans P, Van der Geest P, Mohseni M, Linssen J, De Jonge R, Duran S, Groeneveld J, Miller R, Lopansri BK, McHugh LC, Seldon A, Burke JP, Johnston J, Reece-Anthony R, Bond A, Molokhia A, Mcgrath C, Nsutebu E, Bank Pedersen P, Pilsgaard Henriksen D, Mikkelsen S, Touborg Lassen A, Tincu R, Cobilinschi C, Tomescu D, Ghiorghiu Z, Macovei R, Wiewel MA, Harmon MB, Van Vught LA, Scicluna BP, Hoogendijk AJ, Horn J, Zwinderman AH, Cremer OL, Bonten MJ, Schultz MJ, Van der Poll T, Juffermans NP, Wiersinga WJ, Eren G, Tekdos Y, Dogan M, Acicbe O, Kaya E, Hergunsel O, Alsolamy S, Ghamdi G, Alswaidan L, Alharbi S, Alenezi F, Arabi Y, Heaton J, Boyce A, Nolan L, Johnston J, Dukoff-Gordon A, Dean A, Molokhia A, Mann Ben Yehudah T, Fleischmann C, Thomas-Rueddel D, Haas C, Dennler U, Reinhart K, Suntornlohanakul O, Khwannimit B, Breckenridge F, Puxty A, Szturz P, Folwarzcny P, Svancara J, Kula R, Sevcik P, Caneva L, Casazza A, Bellazzi E, Marra S, Pagani L, Vetere M, Vanzino R, Ciprandi D, Preda R, Boschi R, Carnevale L, Lopez V, Aguilar Arzapalo M, Barradas L, Escalante A, Gongora J, Cetina M, Adamik B, Jakubczyk D, Kübler A, Radford A, Lee T, Singer J, Boyd J, Fineberg D, Williams M, Russell J, Scarlatescu E, Tomescu D, Droc G, Arama S, Müller M, Straat M, Zeerleder SS, Juffermans NP, Fuchs CF, Scheer CS, Wauschkuhn SW, Vollmer MV, Meissner KM, Kuhn SK, Hahnenkamp KH, Rehberg SR, Gründling MG, Yamamoto N, Ojima M, Hamaguchi S, Hirose T, Akeda Y, Takegawa R, Tasaki O, Shimazu T, Tomono K, Gómez-Sánchez E, Heredia-Rodríguez M, Álvarez-Fuente E, Lorenzo-López M, Gómez-Pesquera E, Aragón-Camino M, Liu-Zhu P, Sánchez-López A, Hernández-Lozano A, Peláez-Jareño MT, Tamayo E, Thomas-Rüddel DO, Fleischmann C, Haas C, Dennler U, Reinhart K, Adora V, Kar A, Chakraborty A, Roy S, Bandyopadhyay A, Das M, Mann Ben Yehudah T, BenYehudah G, Salim M, Kumar N, Arabi L, Burger T, Lephart P, Toth-martin E, Valencia C, Hammami N, Blot S, Vincent JL, Lambert ML, Brunke J, Riemann T, Roschke I, Tincu R, Cobilinschi C, Tomescu D, Ghiorghiu Z, Macovei R, Nimitvilai S, Jintanapramote K, Jarupongprapa S, Adukauskiene D, Valanciene D, Bose G, Lostarakos V, Carr B, Khedher S, Maaoui A, Ezzamouri A, Salem M, Chen J, Cranendonk DR, Van Vught LA, Wiewel MA, Cremer OL, Horn J, Bonten MJ, Schultz MJ, Van der Poll T, Wiersinga WJ, Day M, Penrice G, Roy K, Robertson P, Godbole G, Jones B, Booth M, Donaldson L, Kawano Y, Ishikura H, Al-Dorzi H, Almutairi M, Alhamadi B, Crizaldo Toledo A, Khan R, Al Raiy B, Arabi Y, Talaie H, Van Oers JA, Harts A, Nieuwkoop E, Vos P, Boussarsar Y, Boutouta F, Kamoun S, Mezghani I, Koubaji S, Ben Souissi A, Riahi A, Mebazaa MS, Giamarellos-Bourboulis E, Tziolos N, Routsi C, Katsenos C, Tsangaris I, Pneumatikos I, Vlachogiannis G, Theodorou V, Prekates A, Antypa E, Koulouras V, Kapravelos N, Gogos C, Antoniadou E, Mandragos K, Armaganidis A, Robles Caballero AR, Civantos B, Figueira JC, López J, Silva-Pinto A, Ceia F, Sarmento A, Santos L, Almekhlafi G, Sakr Y, Al-Dorzi H, Khan R, Baharoon S, Aldawood A, Matroud A, Alchin J, Al Johani S, Balkhy H, Arabi Y, Alsolamy S, Yousif SY, Alotabi BO, Alsaawi AS, Ang J, Curran MD, Enoch D, Navapurkar V, Morris A, Sharvill R, Astin J, Heredia-Rodríguez M, Gómez-Sánchez E, Peláez-Jareño MT, Gómez-Pesquera E, Lorenzo-López M, Liu-Zhu P, Aragón-Camino M, Hernández-Lozano A, Sánchez-López A, Álvarez-Fuente E, Tamayo E, Patel J, Kruger C, O’Neal J, Rhodes H, Jancik J, François B, Laterre PF, Eggimann P, Torres A, Sánchez M, Dequin PF, Bassi GL, Chastre J, Jafri HS, Ben Romdhane M, Douira Z, Kamoun S, Bousselmi M, Ben Souissi A, Boussarsar Y, Riahi A, Mebazaa MS, Vakalos A, Avramidis V, Craven TH, Wojcik G, Kefala K, McCoubrey J, Reilly J, Paterson R, Inverarity D, Laurenson I, Walsh TS, Mongodi S, Bouhemad B, Orlando A, Stella A, Via G, Iotti G, Braschi A, Mojoli F, Haliloglu M, Bilgili B, Kasapoglu U, Sayan I, Süzer Aslan M, Yalcın A, Cinel I, Vakalos A, Avramidis V, Ellis HE, Bauchmuller K, Miller D, Temple A, Chastre J, François B, Torres A, Luyt CE, Sánchez M, Singer M, Jafri HS, Nassar Y, Ayad MS, Trifi A, Abdellatif S, Daly F, Nasri R, Ben Lakhal S, Bilgili B, Haliloglu M, Gul F, Cinel I, Kuzovlev A, Shabanov A, Polovnikov S, Moroz V, Kadrichu N, Dang T, Corkery K, Challoner P, Bassi GL, Aguilera E, Chiurazzi C, Travierso C, Motos A, Fernandez L, Amaro R, Senussi T, Idone F, Bobi J, Rigol M, Torres A, Hodiamont CJ, Juffermans NP, Janssen JM, Bouman CS, Mathôt RA, De Jong MD, Van Hest RM, Payne L, Fraser GL, Tudor B, Lahner M, Roth G, Krenn C, Talaie H, Jault P, Gabard J, Leclerc T, Jennes S, Que Y, Rousseau A, Ravat F, Al-Dorzi H, Eissa A, Al-Harbi S, Aldabbagh T, Khan R, Arabi Y, Trifi A, Abdellatif. S, Daly F, Nasri R, Ben Lakhal S, Paramba F, Purayil N, Naushad V, Mohammad O, Negi V, Chandra P, Kleinsasser A, Witrz MR, Buchner-Doeven JF, Tuip-de Boer AM, Goslings JC, Juffermans NP, Van Hezel M, Straat M, Boing A, Van Bruggen R, Juffermans N, Markopoulou D, Venetsanou K, Kaldis V, Koutete D, Chroni D, Alamanos I, Koch L, Jancik J, Rhodes H, Walter E, Maekawa K, Hayakawa M, Kushimoto S, Shiraishi A, Kato H, Sasaki J, Ogura H, Matauoka T, Uejima T, Morimura N, Ishikura H, Hagiwara A, Takeda M, Tarabrin O, Shcherbakow S, Gavrychenko D, Mazurenko G, Ivanova V, Chystikov O, Plourde C, Lessard J, Chauny J, Daoust R, Shcherbakow S, Tarabrin O, Gavrychenko D, Mazurenko G, Chystikov O, Vakalos A, Avramidis V, Kropman L, In het Panhuis L, Konings J, Huskens D, Schurgers E, Roest M, De Laat B, Lance M, Durila M, Lukas P, Astraverkhava M, Jonas J, Budnik I, Shenkman B, Hayami H, Koide Y, Goto T, Iqbal R, Alhamdi Y, Venugopal N, Abrams S, Downey C, Toh CH, Welters ID, Bombay VB, Chauny JM, Daoust RD, Lessard JL, Marquis MM, Paquet JP, Siemens K, Sangaran D, Hunt BJ, Durward A, Nyman A, Murdoch IA, Tibby SM, Ampatzidou F, Moisidou D, Dalampini E, Nastou M, Vasilarou E, Kalaizi V, Chatzikostenoglou H, Drossos G, Spadaro S, Fogagnolo A, Fiore T, Schiavi A, Fontana V, Taccone F, Volta C, Chochliourou E, Volakli E, Violaki A, Samkinidou E, Evlavis G, Panagiotidou V, Sdougka M, Mothukuri R, Battle C, Guy K, Mills G, Evans P, Wijesuriya J, Keogh S, Docherty A, O’Donnell R, Brunskill S, Trivella M, Doree C, Holst L, Parker M, Gregersen M, Almeida J, Walsh T, Stanworth S, Moravcova S, Mansell J, Rogers A, Smith RA, Hamilton-Davies C, Omar A, Allam M, Bilala O, Kindawi A, Ewila H, Ampatzidou F, Moisidou D, Nastou M, Dalampini E, Malamas A, Vasilarou E, Drossos G, Ferreira G, Caldas J, Fukushima J, Osawa EA, Arita E, Camara L, Zeferino S, Jardim J, Gaioto F, Dallan L, Jatene FB, Kalil Filho R, Galas F, Hajjar LA, Mitaka C, Ohnuma T, Murayama T, Kunimoto F, Nagashima M, Takei T, Tomita M, Omar A, Mahmoud K, Hanoura S, Sudarsanan S, Sivadasan P, Othamn H, Shouman Y, Singh R, Al Khulaifi A, Mandel I, Mikheev S, Suhodolo I, Kiselev V, Svirko Y, Podoksenov Y, Jenkins SA, Griffin R, Tovar Doncel MS, Lima A, Aldecoa C, Ince C, Taha A, Shafie A, Mostafa M, Syed N, Hon H, Righetti F, Colombaroli E, Castellano G, Righetti F, Colombaroli E, Hravnak M, Chen LC, Dubrawski AD, Clermont GC, Pinsky MR, Gonzalez S, Macias D, Acosta J, Jimenez P, Loza A, Lesmes A, Lucena F, Leon C, Tovar Doncel MS, Ince C, Aldecoa C, Lima A, Bastide M, Richecoeur J, Frenoy E, Lemaire C, Sauneuf B, Tamion F, Nseir S, Du Cheyron D, Dupont H, Maizel J, Shaban M, Kolko R, Salahuddin N, Sharshir M, AbuRageila M, AlHussain A, Mercado P, Maizel J, Kontar L, Titeca D, Brazier F, Riviere A, Joris M, Soupison T, De Cagny B, Slama M, Wagner J, Körner A, Kubik M, Kluge S, Reuter D, Saugel B, Colombaroli E, Righetti F, Castellano G, Tran T, De Bels D, Cudia A, Strachinaru M, Ghottignies P, Devriendt J, Pierrakos C, Martínez González Ó, Blancas R, Luján J, Ballesteros D, Martínez Díaz C, Núñez A, Martín Parra C, López Matamala B, Alonso Fernández M, Chana M, Huber W, Eckmann M, Elkmann F, Gruber A, Klein I, Schmid RM, Lahmer T, Moller PW, Sondergaard S, Jakob SM, Takala J, Berger D, Bastoni D, Aya H, Toscani L, Pigozzi L, Rhodes A, Cecconi M, Ostrowska C, Aya H, Abbas A, Mellinghoff J, Ryan C, Dawson D, Rhodes A, Cecconi M, Cronhjort M, Wall O, Nyberg E, Zeng R, Svensen C, Mårtensson J, Joelsson-Alm E, Aguilar Arzapalo M, Barradas L, Lopez V, Cetina M, Parenti N, Palazzi C, Amidei LA, Borrelli FB, Campanale SC, Tagliazucchi FT, Sedoni GS, Lucchesi DL, Carella EC, Luciani AL, Mackovic M, Maric N, Bakula M, Aya H, Rhodes A, Grounds RM, Fletcher N, Cecconi M, Avard B, Zhang P, Mezidi M, Charbit J, Ould-Chikh M, Deras P, Maury C, Martinez O, Capdevila X, Hou P, Linde-Zwirble WZ, Douglas ID, Shapiro NS, Ben Souissi A, Mezghani I, Ben Aicha Y, Kamoun S, Laribi B, Jeribi B, Riahi A, Mebazaa MS, Pereira C, Marinho R, Antunes R, Marinho A, Crivits M, Raes M, Decruyenaere J, Hoste E, Bagin V, Rudnov V, Savitsky A, Astafyeva M, Korobko I, Vein V, Kampmeier T, Arnemann P, Hessler M, Wald A, Bockbreder K, Morelli A, Van Aken H, Rehberg S, Ertmer C, Arnemann P, Hessler M, Kampmeier T, Rehberg S, Van Aken H, Ince C, Ertmer C, Reddy S, Bailey M, Beasley R, Bellomo R, Mackle D, Psirides A, Young P, Reddy S, Bailey M, Beasley R, Bellomo R, Mackle D, Young P, Venkatesh H, Ramachandran S, Basu A, Nair H, Egan S, Bates J, Oliveira S, Rangel Neto NR, Reis FQ, Lee CP, Lin XL, Choong C, Eu KM, Sim WY, Tee KS, Pau J, Abisheganaden J, Maas K, De Geus H, Lafuente E, Marinho R, Moura J, Antunes R, Marinho A, Doris TE, Monkhouse D, Shipley T, Kardasz S, Gonzalez I, Stads S, Groeneveld AJ, Elsayed I, Ward N, Tridente A, Raithatha A, Steuber A, Pelletier C, Schroeder S, Michael E, Slowinski T, Kindgen-Milles D, Ghabina S, Turani F, Belli A, Busatti S, Barettin G, Candidi F, Gargano F, Barchetta R, Falco M, Demirkiran O, Kosuk M, Bozbay S, Weber V, Hartmann J, Harm S, Linsberger I, Eichhorn T, Valicek G, Miestinger G, Hoermann C, Faenza S, Ricci D, Mancini E, Gemelli C, Cuoghi A, Magnani S, Atti M, Laddomada T, Doronzio A, Balicco B, Gruda MC, O’Sullivan P, Dan VP, Guliashvili T, Scheirer A, Golobish TD, Capponi VJ, Chan PP, Kogelmann K, Drüner M, Jarczak D, Turani F, Belli AB, Martni SM, Cotticelli VC, Mounajergi F, Barchetta R, Morimoto S, Ishikura H, Hussain I, Salahuddin N, Nadeem A, Ghorab K, Maghrabi K, Kloesel SK, Goldfuss C, Stieglitz A, Stieglitz AS, Krstevska L, Albuszies G, Aguilar Arzapalo M, Barradas L, Lopez V, Escalante A, Jimmy G, Cetina M, Izawa J, Iwami T, Uchino S, Takinami M, Kitamura T, Kawamura T, Powell-Tuck JG, Crichton S, Raimundo M, Camporota L, Wyncoll D, Ostermann M, Hana A, De Geus HR, De Geus HR, Hana A, Aydogdu M, Boyaci N, Yuksel S, Gursel G, Cayci Sivri AB, Meza-Márquez J, Nava-López J, Carrillo-Esper R, Dardashti A, Grubb A, Maizel J, Wetzstein M, Titeca D, Kontar L, Brazier F, De Cagny B, Riviere A, Soupison T, Joris M, Slama M, Peters E, Njimi H, Pickkers P, Vincent JL, Waraich M, Doyle J, Samuels T, Forni L, Desai N, Baumber R, Gunning P, Sell A, Lin S, Torrence H, O’Dwyer M, Kirwan C, Prowle J, Kim T, O’Connor ME, Hewson RW, Kirwan CJ, Pearse RM, Prowle J, Hanoura S, Omar A, Othamn H, Sudarsanan S, Allam M, Maksoud M, Singh R, Al Khulaifi A, O’Connor ME, Hewson RW, Kirwan CJ, Pearse RM, Prowle J, Uzundere O, Memis D, Ýnal M, Gultekin A, Turan N, Aydin MA, Basar H, Sencan I, Kapuagasi A, Ozturk M, Uzundurukan Z, Gokmen D, Ozcan A, Kaymak C, Artemenko VA, Budnyuk A, Pugh R, Bhandari S, Mauri T, Turrini C, Langer T, Taccone P, Volta CA, Marenghi C, Gattinoni L, Pesenti A, Sweeney L, O’Sullivan A, Kelly P, Mukeria E, MacLoughlin R, Pfeffer M, Thomas JT, Bregman GB, Karp GK, Kishinevsky EK, Stavi DS, Adi NA, Poropat T, Knafelj R, Llopart E, Batlle M, De Haro C, Mesquida J, Artigas A, Pavlovic D, Lewerentz L, Spassov A, Schneider R, De Smet S, De Raedt S, Derom E, Depuydt P, Oeyen S, Benoit D, Decruyenaere J, Gobatto A, Besen B, Tierno P, Melro L, Mendes P, Cadamuro F, Park M, Malbouisson LM, Civantos BC, Lopez JL, Robles A, Figueira J, Yus S, Garcia A, Oglinda A, Ciobanu G, Oglinda C, Schirca L, Sertinean T, Lupu V, Kelly P, O’Sullivan A, Sweeney L, MacLoughlin R, O’Sullivan A, Kelly P, Sweeney L, Mukeria E, Wolny M, MacLoughlin R, Pagano A, Numis F, Visone G, Saldamarco L, Russo T, Porta G, Paladino F, Bell C, Liu J, Debacker J, Lee C, Tamberg E, Campbell V, Mehta S, Silva-Pinto A, Sarmento A, Santos L, Kara Ý, Yýldýrým F, Zerman A, Güllü Z, Boyacý N, Basarýk Aydogan B, Gaygýsýz Ü, Gönderen K, Arýk G, Turkoglu M, Aydogdu M, Aygencel G, Ülger Z, Gursel G, Boyacý N, Isýkdogan Z, Özdedeoglu Ö, Güllü Z, Badoglu M, Gaygýsýz U, Aydogdu M, Gursel G, Kongpolprom N, Sittipunt C, Eden A, Kokhanovsky Y, Bursztein – De Myttenaere S, Pizov R, Neilans L, MacIntyre N, Radosevich M, Wanta B, Weber V, Meyer T, Smischney N, Brown D, Diedrich D, Fuller A, McLindon P, Sim K, Shoaeir M, Noeam K, Mahrous A, Matsa R, Ali A, Dridi C, Koubaji S, Kamoun S, Haddad F, Ben Souissi A, Laribi B, Riahi A, Mebazaa MS, Pérez-Calatayud A, Carrillo-Esper R, Zepeda-Mendoza A, Diaz-Carrillo M, Arch-Tirado E, Carbognin S, Pelacani L, Zannoni F, Agnoli A, Gagliardi G, Cho R, Adams A, Lunos S, Ambur S, Shapiro R, Prekker M, Thijssen M, Janssen L, Foudraine N, Voscopoulos CJ, Freeman J, Voscopoulos CJ, Freeman J, George E, Voscopoulos CJ, Eversole D, Freeman J, George E, Muttini S, Bigi R, Villani G, Patroniti N, Williams G, Voscopoulos CJ, Freeman J, George E, Waldmann A, Böhm S, Windisch W, Strassmann S, Karagiannidis C, Waldmann A, Böhm S, Windisch W, Strassmann S, Karagiannidis C, Karagiannidis CK, Waldmann AW, Böhm SB, Strassmann S, Windisch WW, Persson P, Lundin S, Stenqvist O, Porta G, Numis F, Serra CS, Pagano AP, Masarone MM, Rinaldi LR, Amelia AA, Fascione MF, Adinolfi LA, Ruggiero ER, Asota F, O’Rourke K, Ranjan S, Morgan P, DeBacker JW, Tamberg E, O’Neill L, Munshi L, Burry L, Fan E, Mehta S, Poo S, Mahendran K, Fowles J, Gerrard C, Vuylsteke A, Loveridge R, Chaddock C, Patel S, Kakar V, Willars C, Hurst T, Park C, Best T, Vercueil A, Auzinger G, Borgman A, Proudfoot AG, Grins E, Emiley KE, Schuitema J, Fitch SJ, Marco G, Sturgill J, Dickinson MG, Strueber M, Khaghani A, Wilton P, Jovinge SM, Sampson C, Harris-Fox S, Cove ME, Vu LH, Sen A, Federspiel WJ, Kellum JA, Mazo Torre C, Riera J, Ramirez S, Borgatta B, Lagunes L, Rello J, Kuzovlev AK, Moroz V, Goloubev A, Polovnikov S, Nenchuk S, Karavana V, Glynos C, Asimakos A, Pappas K, Vrettou C, Magkou M, Ischaki E, Stathopoulos G, Zakynthinos S, Spadaro S, Kozhevnikova I, Dalla Corte F, Grasso S, Casolari P, Caramori G, Volta C, Andrianjafiarinoa T, Randriamandrato T, Rajaonera T, El-Dash S, Costa ELV, Tucci MR, Leleu F, Kontar L, De Cagny B, Brazier F, Titeca D, Bacari-Risal G, Maizel J, Amato M, Slama M, Mercado P, Maizel J, Kontar L, Titeca D, Brazier F, Riviere A, Joris M, Soupison T, De Cagny B, El Dash S, Slama M, Remmington, Fischer A, Squire S, Boichat M, Honzawa H, Yasuda H, Adati T, Suzaki S, Horibe M, Sasaki M, Sanui M, Marinho R, Daniel J, Miranda H, Marinho A, Milinis K, Cooper M, Williams GR, McCarron E, Simants S, Patanwala I, Welters I, Su Y, Fernández Villanueva J, Fernández Garda R, López Lago A, Rodríguez Ruíz E, Hernández Vaquero R, Tomé Martínez de Rituerto S, Varo Pérez E, Lefel N, Schaap F, Bergmans D, Olde Damink S, Van de Poll M, Tizard K, Lister C, Poole L, Ringaitiene D, Gineityte D, Vicka V, Norkiene I, Sipylaite J, O’Loughlin A, Maraj V, Dowling J, Velasco MB, Dalcomune DM, Dias EB, Fernandes SL, Oshima T, Graf S, Heidegger C, Genton L, Karsegard V, Dupertuis Y, Pichard C, Friedli N, Stanga Z, Mueller B, Schuetz P, Vandersteen L, Stessel B, Evers S, Van Assche A, Jamaer L, Dubois J, Marinho R, Castro H, Moura J, Valente J, Martins P, Casteloes P, Magalhaes C, Cabral S, Santos M, Oliveira B, Salgueiro A, Marinho A, Marinho R, Santos M, Lafuente E, Castro H, Cabral S, Moura J, Martins P, Oliveira B, Salgueiro A, Duarte S, Castro S, Melo M, Casteloes P, Marinho A, Gray S, Maipang K, Bhurayanontachai R, Grädel LG, Schütz P, Langlois P, Manzanares W, Tincu R, Cobilinschi C, Tomescu D, Ghiorghiu Z, Macovei R, Manzanares W, Langlois P, Lemieux M, Elke G, Bloos F, Reinhart K, Heyland D, Langlois P, Lemieux M, Aramendi I, Heyland D, Manzanares W, Su Y, Marinho R, Babo N, Marinho A, Hoshino M, Haraguchi Y, Kajiwara S, Mitsuhashi T, Tsubata T, Aida M, Rattanapraphat T, Bhurayanontachai R, Kongkamol C, Khwannimit B, Marinho R, Santos M, Castro H, Lafuente E, Salgueiro A, Cabral S, Martins P, Moura J, Oliveira B, Melo M, Xavier B, Valente J, Magalhaes C, Casteloes P, Marinho A, Moisidou D, Ampatzidou F, Koutsogiannidis C, Moschopoulou M, Drossos G, Taskin G, Çakir M, Güler AK, Taskin A, Öcal N, Özer S, Yamanel L, Wong JM, Fitton C, Anwar S, Stacey S, Aggou M, Fyntanidou B, Patsatzakis S, Oloktsidou E, Lolakos K, Papapostolou E, Grosomanidis V, Suda S, Ikeda T, Ono S, Ueno T, Izutani Y, Gaudry S, Desailly V, Pasquier P, Brun PB, Tesnieres AT, Ricard JD, Dreyfuss D, Mignon A, White JC, Molokhia A, Dean A, Stilwell A, Friedlaender G, Peters M, Stipulante S, Delfosse A, Donneau AF, Ghuysen A, Feldmann C, Freitag D, Dersch W, Irqsusi M, Eschbach D, Steinfeldt T, Wulf H, Wiesmann T, Kongpolprom N, Cholkraisuwat J, Beitland S, Nakstad E, Stær-Jensen H, Drægni T, Andersen G, Jacobsen D, Brunborg C, Waldum-Grevbo B, Sunde K, Hoyland K, Pandit D, Hayakawa K, Oloktsidou E, Kotzampassi K, Fyntanidou B, Patsatzakis S, Loukipoudi L, Doumaki E, Grosomanidis V, Yasuda H, Admiraal MM, Van Assen M, Van Putten MJ, Tjepkema-Cloostermans M, Van Rootselaar AF, Horn J, Ragusa F, Marudi A, Baroni S, Gaspari A, Bertellini E, Taha A, Abdullah T, Abdel Monem S, Alcorn S, McNeill S, Russell S, Eertmans W, Genbrugge C, Meex I, Dens J, Jans F, De Deyne C, Cholkraisuwat J, Kongpolprom N, Avard B, Burns R, Patarchi A, Spina T, Tanaka H, Otani N, Ode S, Ishimatsu S, Cho J, Moon JB, Park CW, Ohk TG, Shin MC, Won MH, Dakova S, Ramsheva Z, Ramshev K, Cho J, Moon JB, Park CW, Ohk TG, Shin MC, Cho J, Moon JB, Park CW, Ohk TG, Shin MC, Marudi A, Baroni S, Gaspari A, Bertellini E, Orhun G, Senturk E, Ozcan PE, Sencer S, Ulusoy C, Tuzun E, Esen F, Tincu R, Cobilinschi C, Tomescu D, Ghiorghiu Z, Macovei R, Van Assen M, Admiraal MM, Van Putten MJ, Tjepkema-Cloostermans M, Van Rootselaar AF, Horn J, Fallenius M, Skrifvars MB, Reinikainen M, Bendel S, Raj R, Abu-Habsa M, Hymers C, Borowska A, Sivadhas H, Sahiba S, Perkins S, Rubio J, Rubio JA, Sierra R, English S, Chasse M, Turgeon A, Lauzier F, Griesdale D, Garland A, Fergusson D, Zarychanski R, Tinmouth A, Van Walraven C, Montroy K, Ziegler J, Dupont Chouinard R, Carignan R, Dhaliwal A, Lum C, Sinclair J, Pagliarello G, McIntyre L, English S, Chasse M, Turgeon A, Lauzier F, Griesdale D, Garland A, Fergusson D, Zarychanski R, Tinmouth A, Van Walraven C, Montroy K, Ziegler J, Dupont Chouinard R, Carignan R, Dhaliwal A, Lum C, Sinclair J, Pagliarello G, McIntyre L, Groza T, Moreau N, Castanares-Zapatero D, Hantson P, Carbonara M, Ortolano F, Zoerle T, Magnoni S, Pifferi S, Conte V, Stocchetti N, Carteron L, Suys T, Patet C, Quintard H, Oddo M, Rubio JA, Rubio J, Sierra R, Spatenkova V, Pokorna E, Suchomel P, Ebert N, Jancik J, Rhodes H, Bylinski T, Hawthorne C, Shaw M, Piper I, Kinsella J, Kink AK, Rätsep IR, Boutin A, Moore L, Chasse M, Zarychanski R, Lauzier F, English S, McIntyre L, Lacroix J, Griesdale D, Lessard-Bonaventure P, Turgeon AF, Boutin A, Moore L, Green R, Lessard-Bonaventure P, Erdogan M, Butler M, Lauzier F, Chasse M, English S, McIntyre L, Zarychanski R, Lacroix J, Griesdale D, Desjardins P, Fergusson DA, Turgeon AF, Goncalves B, Vidal B, Valdez C, Rodrigues AC, Miguez L, Moralez G, Hong T, Kutz A, Hausfater P, Amin D, Struja T, Haubitz S, Huber A, Mueller B, Schuetz P, Brown T, Collinson J, Pritchett C, Slade T, Le Guen M, Hellings S, Ramsaran R, Alsheikhly A, Abe T, Kanapeckaite L, Abu-Habsa M, Bahl R, Russell MQ, Real KJ, Abu-Habsa M, Lyon RM, Oveland NP, Penketh J, Mcdonald M, Kelly F, Alfafi M, Alsolamy S, Almutairi W, Alotaibi B, Van den Berg AE, Schriel Y, Dawson L, Meynaar IA, Talaie H, Silva D, Fernandes S, Gouveia J, Santos Silva J, Foley J, Kaskovagheorgescu A, Evoy D, Cronin J, Ryan J, Huck M, Hoffmann C, Renner J, Laitselart P, Donat N, Cirodde A, Schaal JV, Masson Y, Nau A, Leclerc T, Howarth O, Davenport K, Jeanrenaud P, Raftery S, MacTavish P, Devine H, McPeake J, Daniel M, Kinsella J, Quasim T, Alrabiee S, Alrashid A, Alsolamy S, Gundogan O, Bor C, Akýn Korhan E, Demirag K, Uyar M, Frame F, Ashton C, Bergstrom Niska L, Dilokpattanamongkol P, Suansanae T, Suthisisang C, Morakul S, Karnjanarachata C, Tangsujaritvijit V, Mahmood S, Al Thani H, Almenyar A, Vakalos A, Avramidis V, Sharvill R, Penketh J, Morton SE, Chiew YS, Pretty C, Chase JG, Shaw GM, Knafelj R, Kordis P, Patel S, Grover V, Kuchyn I, Bielka K, Aidoni Z, Grosomanidis V, Kotzampassi K, Stavrou G, Fyntanidou B, Patsatzakis S, Skourtis C, Lee SD, Williams K, Weltes ID, Berhane S, Arrowsmith C, Peters C, Robert S, Caldas J, Panerai RB, Robinson TG, Camara L, Ferreira G, Borg-Seng-Shu E, De Lima Oliveira M, Mian NC, Santos L, Nogueira R, Zeferino SP, Jacobsen Teixeira M, Galas F, Hajjar LA, Killeen P, McPhail M, Bernal W, Maggs J, Wendon J, Hughes T, Taniguchi LU, Siqueira EM, Vieira Jr JM, Azevedo LC, Ahmad AN, Abu-Habsa M, Bahl R, Helme E, Hadfield S, Loveridge R, Shak J, Senver C, Howard-Griffin R, Wacharasint P, Fuengfoo P, Sukcharoen N, Rangsin R, Sbiti-Rohr D, Schuetz P, Na H, Song S, Lee S, Jeong E, Lee K, Cooper M, Milinis K, Williams G, McCarron E, Simants S, Patanwala I, Welters ID, Zoumpelouli E, Volakli EA, Chrysohoidou V, Georgiou S, Charisopoulou K, Kotzapanagiotou E, Panagiotidou V, Manavidou K, Stathi Z, Sdougka M, Salahuddin N, AlGhamdi B, Marashly Q, Zaza K, Sharshir M, Khurshid M, Ali Z, Malgapo M, Jamil M, Shafquat A, Shoukri M, Hijazi M, Abe T, Uchino S, Takinami M, Rangel Neto NR, Oliveira S, Reis FQ, Rocha FA, Moralez G, Ebecken K, Rabello LS, Lima MF, Hatum R, De Marco FV, Alves A, Pinto JE, Godoy M, Brasil PE, Bozza FA, Salluh JI, Soares M, Krinsley J, Kang G, Perry J, Hines H, Wilkinson KM, Tordoff C, Sloan B, Bellamy MC, Moreira E, Verga F, Barbato M, Burghi G, Soares M, Silva UV, Azevedo LC, Torelly AP, Kahn JM, Angus DC, Knibel MF, Brasil PE, Bozza FA, Salluh JI, Velasco MB, Dalcomune DM, Marshall R, Gilpin T, Tridente A, Raithatha A, Mota D, Loureiro B, Dias J, Afonso O, Coelho F, Martins A, Faria F, Al-Dorzi H, Al Orainni H, AlEid F, Tlaygeh H, Itani A, Hejazi A, Arabi Y, Gaudry S, Messika J, Ricard JD, Guillo S, Pasquet B, Dubief E, Dreyfuss D, Tubach F, Battle C, James K, Temblett P, Davies L, Battle C, Lynch C, Pereira S, Cavaco S, Fernandes J, Moreira I, Almeida E, Seabra Pereira F, Malheiro M, Cardoso F, Aragão I, Cardoso T, Fister M, Knafelj R, Muraray Govind P, Brahmananda Reddy N, Pratheema R, Arul ED, Devachandran J, Velasco MB, Dalcomune DM, Knafelj R, Fister M, Chin-Yee N, D’Egidio G, Thavorn K, Heyland D, Kyeremanteng K, Murchison AG, Swalwell K, Mandeville J, Stott D, Guerreiro I, Devine H, MacTavish P, McPeake J, Quasim T, Kinsella J, Daniel M, Goossens C, Marques MB, Derde S, Vander Perre S, Dufour T, Thiessen SE, Güiza F, Janssens T, Hermans G, Vanhorebeek I, De Bock K, Van den Berghe G, Langouche L, Devine H, MacTavish P, Quasim T, Kinsella J, Daniel M, McPeake J, Miles B, Madden S, Devine H, Weiler M, Marques P, Rodrigues C, Boeira M, Brenner K, Leães C, Machado A, Townsend R, Andrade J, MacTavish P, McPeake J, Devine H, Kinsella J, Daniel M, Kishore R, Fenlon C, Quasim T, Fiks T, Ruijter A, Te Raa M, Spronk P, Chiew YS, Docherty P, Dickson J, Moltchanova E, Scarrot C, Pretty C, Shaw GM, Chase JG, Hall T, Ngu WC, Jack JM, Morgan P, Avard B, Pavli A, Gee X, Bor C, Akin Korhan E, Demirag K, Uyar M, Shirazy M, Fayed A, Gupta S, Kaushal A, Dewan S, Varma A, Ghosh E, Yang L, Eshelman L, Lord B, Carlson E, Helme E, Broderick R, Hadfield S, Loveridge R, Ramos J, Forte D, Yang F, Hou P, Dudziak J, Feeney J, Wilkinson K, Bauchmuller K, Shuker K, Faulds M, Raithatha A, Bryden D, England L, Bolton N, Tridente A, Bauchmuller K, Shuker K, Tridente A, Faulds M, Matheson A, Gaynor J, Bryden D, S South Yorkshire Hospitals Research Collaboration. Ramos J, Peroni B, Daglius-Dias R, Miranda L, Cohen C, Carvalho C, Velasco I, Forte D, Kelly JM, Neill A, Rubenfeld G, Masson N, Min A, Boezeman E, Hofhuis J, Hovingh A, De Vries R, Spronk P, Cabral-Campello G, Aragão I, Cardoso T, Van Mol M, Nijkamp M, Kompanje E, Ostrowski P, Omar A, Kiss K, Köves B, Csernus V, Molnár Z, Hoydonckx Y, Vanwing S, Stessel B, Van Assche A, Jamaer L, Dubois J, Medo V, Galvez R, Miranda JP, Stone C, Wigmore T, Arunan Y, Wheeler A, Bauchmuller K, Bryden D, Wong Y, Poi C, Gu C, Molmy P, Van Grunderbeeck N, Nigeon O, Lemyze M, Thevenin D, Mallat J, Ramos J, Correa M, Carvalho RT, Forte D, Fernandez A, McBride C, Koonthalloor E, Walsh C, Webber A, Ashe M, Smith K, Jeanrenaud P, Marudi A, Baroni S, Ragusa F, Bertellini E, Volakli EA, Chochliourou E, Dimitriadou M, Violaki A, Mantzafleri P, Samkinidou E, Vrani O, Arbouti A, Varsami T, Sdougka M, Bollen JA, Van Smaalen TC, De Jongh WC, Ten Hoopen MM, Ysebaert D, Van Heurn LW, Van Mook WN, Sim K, Fuller A, Roze des Ordons A, Couillard P, Doig C, Van Keer RV, Deschepper RD, Francke AF, Huyghens LH, Bilsen JB, Nyamaizi B, Dalrymple C, Molokhia A, Dobru A, Marrinan E, Ankuli A, Molokhia A, McPeake J, Struthers R, Crawford R, Devine H, Mactavish P, Quasim T, Morelli P, Degiovanangelo M, Lemos F, MArtinez V, Verga F, Cabrera J, Burghi G, Rutten A, Van Ieperen S, De Geer S, Van Vugt M, Der Kinderen E, Giannini A, Miccinesi G, Marchesi T, Prandi E. 36th International Symposium on Intensive Care and Emergency Medicine : Brussels, Belgium. 15-18 March 2016. Crit Care. 2016 Apr 20;20(Suppl 2):94. [PMC free article: PMC5493079] [PubMed: 27885969]

Anoxia

This type of brain damage (encephalopathy) is caused by a partial (hypoxia) or complete (anoxia) lack of oxygen supply to the brain tissues for a time longer than the time of maintaining the life of neurons..

Oxygen is very important for normal brain function.

The brain makes up 2% of body weight, while consuming 20% ​​of the oxygen that enters the body.

The brain has an enormous capacity to store nutrients, which requires a constant supply of large amounts of oxygen.

That is why the brain tissue can be without oxygen supply for 4-5 minutes, and only after this time the damage to the brain tissue begins to appear. The longer the anoxia time, the higher the level of tissue damage. So, in 15 minutes of lack of oxygen, about 95% of brain tissues die

Causes

Reduced oxygen supply can be caused by various causes, the most common being heart and respiratory failure. It is also necessary to distinguish between cardio-vascular insufficiency and hypoxia, which coexist together, but provoke the formation of different types of brain damage, the clinical picture of which is different.

ISCHEMIA is associated with a decrease in cerebral blood supply, which reduces the supply of oxygen to the brain (hypoxia). As a result of impaired blood circulation, metabolic products (toxins) that increase brain damage due to ischemia are not removed from the brain

HYPOXIA is a decrease in oxygen supply or use. In the case of isolated hypoxia, a compensatory mechanism of increased blood circulation comes into play, which makes it possible to supply the required amount of glucose to the brain and remove toxins in a limited amount of time.
Depending on the mechanism, the following types of hypoxic brain damage are distinguished.

Anoxic anoxia

due to altitude, the oxygen content in the air is reduced. Other causes include total and incomplete drowning, suffocation, choking, airway obstruction, severe asthma attack, anaphylactic shock, and others.

Anemic anoxia

Caused by lack of oxygen supply to the brain due to low hemoglobin or inability of hemoglobin to bind oxygen

Ischemic anoxia/hypoxia

Caused by low oxygen supply to the brain due to poor circulation or low blood pressure. This mechanism is the main cause of anoxic encephalopathy and includes strokes, cerebral hemorrhages, prolonged acute hypotension, and cardiac arrest.

Cardiac arrest is the main cause of hypoxic brain injury and is usually due to cardiac arrhythmia

The most common causes of problems in newborns are poor blood circulation between mother and unborn child, placental abruption, umbilical cord compression, uterine rupture and others.

TOXIC Anoxia is caused by toxins or substances that bind oxygen, such as carbon monoxide, cyanide, drugs, alcohol, formaldehyde, acetone, toluene, and some anesthetics.

Consequences

The degree of damage caused by the absence of oxygen in the tissues of the brain depends on various factors:

The clinical picture of the disease and symptoms depend on the sensitivity of a certain area of ​​the brain to the concentration of oxygen in the tissues. The most sensitive areas:

  • Hippocampus. Zone CA1 and CA4-6, responsible for the assimilation of new information
  • Basal ganglia (caudate and lenticular nuclei) responsible for movement.
  • Cerebellar Purkinje cells responsible for motor coordination
  • Border areas of the vascular system responsible for processing information between different areas of the brain
  • Some layers of the cortex (3, 5, 6) of the brain responsible for cognitive functions

Most common symptoms:

  • Epileptic crises. Every third patient with anoxia has epileptic crises, the clinical picture of which differs from typical convulsions and takes the form of complex partial crises (with impaired consciousness) or muscle twitches (myoclonus)
  • Movement disorder includes rigid akinetic parkinsonism with dystonic postures. Muscle twitches, choreic movements, abnormally slow, uncontrolled movements (athetosis), and tremors also occur.
  • Sensorimotor disorders include tetraparesis, paraparesis, and others.
  • Visual disturbances – from fixation problem to cortical blindness
  • Disorders of consciousness, including vegetative state and state of minimal consciousness
  • Cognitive problems manifested in impaired attention and learning

The spectrum of the clinical picture of this disease is very wide, it can manifest itself as minor cognitive impairment up to brain death. In general, about 65% of patients with this disease remain with limited abilities and dependent on other people. This type of brain damage gives the worst prognosis compared to other injuries, especially in the motor and cognitive spheres.

FGBNU NTsPZ. ‹‹Exogenous mental disorders››

Feedback form

Question about the work of the siteQuestion to a specialistQuestion to the administration of the clinic

email address

Name

Message text

The morphological picture of the brain in various clinical forms of alcoholism can be different – from approaching normal to severe atrophy and acute dystrophic changes. It depends on the stage of the disease, the duration of alcohol consumption, as well as many additional factors.

In those who died in a state of acute alcohol intoxication, which is relatively rare, one can see hyperemia and swelling of the brain, less often pinpoint hemorrhages, which also corresponds to the microscopic picture of the brain tissue. It is dominated by circulatory disorders and more or less pronounced signs of toxic encephalopathy.

With delirium tremens, swelling or pronounced swelling of the brain is macroscopically noteworthy, the hemorrhagic syndrome is unstable. Microscopically, hemorrhages in the brain stem are detected, as well as diffuse phenomena of toxic-anoxic encephalopathy, including pronounced granular decay and vacuolar degeneration of neurocytes. There is a predominant lesion of the stem, in particular the hypothalamic, parts of the brain. This corresponds to changes in the endocrine glands that are characteristic of a state of stress (according to Selye) With delirium tremens, changes in internal organs are possible, dystrophic phenomena in the heart and kidneys, severe fatty degeneration, and sometimes the initial stage of cirrhosis of the liver

The neuroanatomy of chronic alcoholism reflects both the direct toxic effect of alcohol and its indirect effect on the brain caused by alimentary deficiency (especially of B vitamins), as well as metabolic disorders due to alcoholic liver damage.

Histopathological manifestations of chronic alcoholism are characterized by a picture of encephalopathy, while there is a combination of two types of encephalopathy – toxic and alimentary-dystrophic [Snesarev P. E., 1950]. In some, especially in severe cases of chronic alcoholism, atrophy of the brain parenchyma may develop, which is microscopically expressed by the disappearance of nerve cells in the cerebral cortex and cerebellum. Usually there are dystrophic changes in the peripheral nerves, and sometimes the optic nerve. The phenomena of cirrhosis of the liver are also characteristic.

In Gaye-Wernicke disease, microscopically observed dot and spotted hemorrhages and small necrosis in the walls of the third ventricle, the trunk and diencephalic region of the brain and mamillary bodies, less often in the tissue of the corpus callosum and cerebellum. Microscopically, small hemorrhages and their consequences, gliosis reaction, dystrophic changes in nerve cells and their death, signs of cerebral edema are detected. Liver changes are not always found, but in some cases they are very pronounced and reach the degree of cirrhosis (fatty alcoholic cirrhosis). There is an opinion that Gaye-Wernicke encephalopathy is largely due to the development of thiamine deficiency in alcoholism. This encephalopathy is considered one of the most severe forms of alcoholic brain damage.

In Korsakov’s syndrome, vascular disorders of an ischemic nature predominate in the picture of encephalopathy, especially often found in the dorsomedial thalamic nuclei, mamillary bodies, and some other subcortical formations.

In some cases of severe alcoholism, degeneration of the cerebellar tissue (usually its anterior region) is noted. Even rarer findings include lesions of the myelin sheaths of the nerve conductors in the central part of the brain stem and changes corresponding to the picture of Markjafava-Bignyami disease, caused by the processes of demyelination of the medial part of the corpus callosum.

The anatomical basis of fetal alcohol syndrome is brain dysontogenesis, the signs of which are already found in fetuses of 5-15 weeks of development [Kovetsky N. S. et al., 1988]. The most typical changes include disturbances in the formation of the walls of the brain, deviations in the development of the cortical plate with aplasia, developmental delay, and less often in combination with hyperplasia of individual sections of these structures. Quite characteristic of these cases is also the formation of the walls of the brain with excessive folding and fusion of their individual sections with the formation of various variants of porencephaly and cysts; quite typical is the heterotopy of nerve elements and their groups. The described changes were generally designated as “violations of the general structure of the brain” [Konovalov G. V. et al., 1988]. Pronounced changes were established in fetal alcohol syndrome and in the ultrastructural study of the brain of fetuses developing in the body of alcoholic mothers [Solonsky A.V., Kovetsky N.S., 1989].

Many authors believe that the main mechanism of the teratogenic effect of alcohol on the developing brain is a violation of the migration of neurons and glial elements, which leads to their heterotopy in the white matter, meninges, changes in the structure of the layers of the cortex of the cerebral hemispheres, as well as hypoplasia of some of its departments [Clarren S.