What is Hypoxic-Ischemic Encephalopathy?

HIE or Hypoxic-ischemic encephalopathy is a condition where the brain does not receive enough oxygen.

HIE
MRI Brain

This can occur if there is a problem getting the blood to the brain, for example if the heart is not pumping adequately, or if there is not enough oxygen in the blood which can occur if someone is not breathing adequately.

The extent and location of brain injury depends on how severe the loss of oxygen, and amount of time the oxygen has not been available to the brain. It also depends upon the age of the baby.

Hypoxic Ischemic Encephalopathy in Neonates

Babies born prior to the expected delivery time are most susceptible. If HIE occurs before 35 weeks of birth it results in cysts in the brain tissue called periventricular leukomalacia or PVL.

Hypoxic ischemic encephalopathy can occur in intrauterine life before birth, at the time of birth and after birth. There are many risk factors including:

  • Low blood pressure in the mother
  • Infection
  • Forceps or breech delivery
  • Umbilical cord prolapse

Short Term and Long Term Effects of HIE

There are short term and long term effects of HIE. Short term include bleeding in the brain and seizures. Long term effects depend on severity and location and can range from epilepsy to delayed milestones and motor movement disorder like cerebral palsy.

Detecting Hypoxic Ischemic Encephalopathy

Sometimes it can be difficult to detect an episode of HIE. In hospital or intensive care it can be detected by a change in feeding and breathing pattern. The body may become stiff or floppy ,or the patient may experience hypoxic ischemic encephalopathy and seizures.

Hypoxic Ischemic Encephalopathy in Children

For older children an eyewitness may have to give details as usually the patient would not remember the episode.

Hypoxic Ischemic Encephalopathy MRI

When HIE is suspected, imaging can play an important role using ultrasound, CT or MRI. MRI is the preferred method as there is no radiation and is excellent in detecting the extent of HIE in the brain.

MRI may give us important information about the diagnosis about any complications and determine extent of injury with possible long term effects. A second medical opinion is best practice when analysing the results of the MRI scan for such a complex condition.

Seizures and epilepsy in Childhood

It is a terrifying experience for family members who witness their loved ones, especially children, have an episode of seizures or further on, be diagnosed with epilepsy.

In many cases seizures that take place at home have not subsequently been picked up in hospitals by even the most sophisticated scanning. This can cause doctors or parents to believe they are imagining that their child has epilepsy. This is a frustrating situation for a parent to be in, and fortunately most doctors will now listen sympathetically to parents and treat them as a primary information source in helping to manage and correctly diagnose their children’s health.

What is a seizure?

Seizures occur when there is a short period of sudden surge of electrical activity from the brain, causing our body to act in a certain way. When someone has a tendency of recurrent seizures over a longer period of time, then it is called epilepsy.

seizures
MRI brain

This electrical activity may occur from one small area or the entire brain, this determines if the seizure will occur in one part of the body or be generalized. Although having a single episode of seizure does not mean there will have more seizures, it does however increase an individual’s chances of having more. Seizures are not rare in children, and they do not necessarily mean a dangerous pathology. However, a history of seizures in the family does makes it more likely for them to develop epilepsy.

Causes of Seizures in Children

There are many causes of seizures and epilepsy which vary from newborn to older age however, in many cases the cause of seizures may be unknown.

Common causes are:

  • Structural abnormalities in the developing brain,
  • Decreased levels of electrolytes in the blood,
  • Bleeding in the brain and
  • Low blood or oxygen supply to the brain in newborn and infants less than 1 year age There are also a number of causes which affect all age groups including: infections such as meningitis or encephalitis and stroke. Also, within the 60’s age group, brain atrophy and degenerative conditions such as Alzheimer’s disease can cause seizures.
  • Space occupying lesions can affect any age group, however in children specific lesions are more prone to causing seizures than other ages.

Diagnosis of Seizures

Diagnosis of seizures can be difficult, as the person having the seizure may not remember what has taken place. Within children they will rely on parents or loved ones to recount this for them and take action.

The doctor will perform a neurological examination including a test that measures the electrical activity of the brain called EEG. Imaging tests such as computerized tomography (CT)and magnetic resonance imaging (MRI)may be required. In paediatrics MRI are preferred due to the absence of radiation exposure, however under 5 years of age MRI requires general anaesthesia. CT is the preferred option in acute settings.

Diagnosis from scanscan be open to interpretation and therefore could possible lead to a misdiagnosis. If you’ve visited a doctor and are having doubts, asecond medical opinioncan reduce the risk of a misdiagnosis by up to 90%. Diagnose.me can help.

How to overcome patient “shyness” and seek a second medical opinion

In the UK, patients are fortunate to have significant choice in their treatment within the NHS. The NHS (National Health Service) provides a high standard of care throughout the country, offering access to experienced and skilled medical practitioners within well-equipped facilities.

However, as a nation we have a reputation of being reticent about discussing our health problems, even with a medical professional, and are reluctant to question a doctor’s decision during a consultation. While there is every reason for a patient to trust their doctor and to treat them with respect, there are also occasions when a patient may want to ask questions about their diagnosis or treatment plan – and should feel comfortable to do so. This includes getting a second medical opinion.  Recent research1 found that a little over half (52%) of Britons are aware that they are entitled to ask a GP or health professional (such as a consultant) for a second opinion about their diagnosis or treatment.

Here’s the 5 key points every patient needs to know about seeking a second medical opinion:

1.  When do I need a second opinion?

Before you ask for a second opinion, it’s worth asking your GP or consultant to talk you through your diagnosis again and explain anything that you don’t understand. If you have had X-Rays or MRI scans, then you could also ask your doctor to show you the image and point out any irregularities. However, if you still have doubts about your diagnosis, are confronted with a difficult diagnosis or you’re facing an invasive treatment like surgery, seeking a second medical opinion can help you to make informed choices about your health.

2.  Will my doctor be offended if I ask for a second opinion?

This is a common misconception in the UK – in fact a recent survey1 found that a fifth of those asked (21%) said that concern about upsetting or angering their doctor would stop them from asking for a second medical opinion. Although, they are fully entitled to ask their GP or health professional for a second or further opinion (an opinion about your health condition from a different doctor). Although you do not have a legal right to a second opinion, a health care professional should not see this as a sign of mistrust and should refer you. Within the medical profession it is actually very common for doctors to ask colleagues for a second medical opinion and radiologists commonly “double” read examinations, as well as treatment decisions being made as part of a wider multi-disciplinary team meeting.

3.  Can I ask for an opinion from another consultant?

Yes. If you would like a second opinion after seeing a consultant, you need to go back to your GP and ask them to refer you again. The consultant giving the second opinion will then be sent all your relevant test results or scans (e.g. X-Rays or MRI images). In the NHS, you may have to wait several weeks or months to see a different consultant for a second medical opinion and will usually need to travel to a different hospital. This could delay any treatment you may need, so you need to ask yourself if this could be harmful to your health and recovery.

4.  If I’m feeling unwell, can someone else ask for a second medical opinion on my behalf?

A member of your family or a carer can ask on your behalf – but only with your consent. If you’re happy for someone to act on your behalf, it is advisable to give them all the information about your condition and check that they understand it well.

5.  Where else can I seek a second medical opinion?

If you have private medical insurance, you could ask your GP or consultant for a referral to seek a second medical opinion. You can also book an appointment with a consultant privately as a “self-pay” patient – however, if you take this option, do double-check the price per consultation and for additional scans.

With the rise of reputable medical services available on the internet, you can now seek a professional second medical opinion online. Services such as Diagnose.me, a specialist online health platform, connect patients seeking a second opinion with some of the world’s leading specialists. They will find, confirm or correct a patient’s diagnosis. Diagnose.me expert radiologists correct the original diagnosis in 26%2 of second opinion cases helping 15%2 of patients to avoid unnecessary treatment.


References:
1. ComRes interviewed 2,010 GB adults online between 3rd and 4th June 2015. Data were weighted to be representative of all GB adults aged 18+.
2. Diagnose.me statistics

5 Ways to get the most from your Doctor/Patient Relationship

A good doctor patient partnership is based on trust and honest communication, like all healthy relationships.

Here is a useful guide to help you get the most from that partnership and avoid any doctor patient relationship problems. It will ensure that your doctor understands your symptoms and can make an accurate diagnosis and advise on the best treatment pathway.

Be prepared

Do your ‘homework’ thoroughly before visiting the doctor to make the best use of your time.

With studies suggesting that the average consultation with a doctor is 8 minutes in the UK, being prepared not only makes efficient use of your doctor’s time but you’re also more likely to get an accurate diagnosis and subsequent medical care too.

So, if you are visiting a doctor for a first consultation or a second medical opinion, make sure you;

  • keep a diary of your symptoms and make sure you take this to your consultation
  • do some research online into your symptoms and write a list of written questions
  • take a pen and paper to write down notes (studies have shown patients can forget about 50% of what a doctor tells them during a visit)

Be truthful

Tell your doctor all of your symptoms, starting from the time you first noticed that something wasn’t quite right. If you have written a diary on your condition and how it is affecting you – all the better. Be sure to inform the doctor of remedies you have already tried and whether you have seen another health care professional about the problem or issue.

There is no need to be shy or embarrassed about any problems, they have ‘seen it all’ and ‘heard it all’ before. They will not make a moral judgement of you or break any doctor patient relationship trust.

Make sure to always inform your doctor of any medication you are taking.

Ask about your diagnosis

Do not feel embarrassed or shirk from asking your doctor what he thinks is wrong with you. Surprisingly, many doctors are reluctant to give a name to a patient’s problems, so if you do not ask that specific question, you may not get an answer.

Make sure you ask your doctor to explain your diagnosis and how it may affect you and your family;

  • What is my diagnosis?
  • What is my prognosis?
  • Do I need any additional tests or examinations?
  • Is it possible to get a copy of any test results or scans for a second medical opinion?
  • What changes, if any, will I need to make in my daily life?
  • Will I need special help at home for my condition? If so, what type of help?

It’s all in the detail

Doctors aren’t mind-readers. You must tell them everything you know, think, and feel about your problem if you want an accurate diagnosis and the best treatment plan for your condition. You are entitled to raise relevant questions and to seek satisfactory answers to them in clear, plain English. It may help to ask for supporting or background reading material on your condition.

Some people find it useful taking a friend or relative to the consultation, as their presence can be calming but useful too. They can encourage you to ask relevant questions, and help you to interpret the doctor’s statements.

Copies of test reports and scans

Make sure you have copies of all your medical records and tests. You can give them to the doctor for his/her files, if needed – but keep your originals with you as they are your property. And, if you’re not completely happy with your initial diagnosis be aware that you can seek a second medical opinion? Diagnose.me is a specialist online health platform, which connects patients seeking a second opinion with some of the world’s leading specialists. They will find, confirm or correct a patient’s diagnosis. They only need the patient’s X-Ray, CT, PET-CT, ultrasound or MRI scans.

Visit diagnose.me for more information.


References:
1. Howie JG, Heaney DJ, Maxwell M, et al; Quality at general practice consultations: cross sectional survey. BMJ. 1999 Sep 18;319(7212):738-43