Cerebral hypoxia laboratory findings
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Overview
Head CT scan is consider as most important investigation in the diagnosis of the cerebral hypoxia.
Laboratory Findings
- In the acute period after the presentation to the hospital, laboratory, and radiological evaluation of a patient with hypoxic brain injury are dictated by the underlying cause of the injury. Initial studies should include basic blood work, including blood glucose, electrolyte panel, a complete blood count, a blood urea nitrogen, serum creatinine, and liver function studies.
- An arterial blood gas is often indicated to evaluate the acid-base status and rule out hypercarbia.
- A urine drug screen and/or blood alcohol level is useful, but it is important to note that many medications and drugs of abuse are not detected by routine urine tests; consequently, a negative UDS is not sufficient to exclude the possibility of drug intoxication or overdose.
- A non-contrast head CT should be performed in all patients with depressed level of consciousness, to evaluate for structural lesions. Head CT is sufficient to detect acute hemorrhage, hydrocephalus, and evidence of traumatic injuries such as skull fractures.
- The primary indication for obtaining a head CT is to identify mass lesions that may require intervention, such as a subdural hematoma or acute hydrocephalus. Often in the setting of an acute hypoxic brain injury, the CT may be relatively unremarkable.
- However, the loss of gray-white differentiation may be appreciated. This can be quantified by measuring the Hounsfield units of the cerebral cortex and underlying white matter; the ratio of these values has been shown to correlate with prognosis. [10]
- For patients who remain comatose after resuscitation, further evaluation may be required. CT angiography and/or CT perfusion may be performed if an acute stroke is suspected, and may also be valuable to rule out vascular injuries in patients who have experienced cervical trauma.
- Electroencephalography is valuable to rule out nonconvulsive status epilepticus. MRI is more sensitive for hypoxic injury than CT, and has been correlated with prognosis; this is discussed in more detail in subsequent sections.