Hypoxic and anoxic brain injury | Headway

Hypoxic and anoxic brain injury | Headway
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"But you don't look disabled"
Shana Lewis
Robert Ashton
Laura Bailey 2015
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Mel Lightfoot
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Denise Johnson
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Terisha Burge
Maria Knights
Joanne Davis
Sarah Whitchurch
Amy Perring
Jane Clarke
Peter Holmes
Luke Flavell
Lindsay Lapham
Pip Taylor
Nic O'Leary
Angus Swanson
Tom Birch
Samuel Bishop
Phil Broxton
Nell Gregory
Jamie Gailer
Kate and John Bosley
Gary Winters
Kathryn Edgington
Charlie and Jake Korving
Bruno Muratori
Kerry Jeffs
Mike McCall
James Piercy
Andy Nicholson
Warren McKinlay
Lauren and Claire Cowlishaw
David Horner
Arthur Moore
Mike Palmer
Sarah Tomlinson
Paul Leyland
Tina Young
Warwick Jarvis
Jackie and John Mills
Adrian Ellis
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Eleanor Simcox
Jack Rutter
Jan Luxton
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Rebecca Grant
Rachel Atkinson
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Brenda and Julian
Callum Maclean
A simple solution
Lost in a crowd
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Dear my new brain
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The new me and my Jumbledbrain blog
The old me is not the new me
I see Headway as the pit stop
Riding my horse Johnny keeps me focused
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Brain injury didn't steal my future
Never give up
Anna Khan
Fiona Grant-MacDonald
Kiran Higgins
Jetting off alone
Dad 2.0
Dislabeled
Matt Brammeier
Syreeta
Brain injury vs family
The Face of Brain Injury With Dee Snider
Mourning lost relationships
A mother's perspective
Pathological laughter - it's no joke
HiddenInMe
Polly Williamson
Writing a book after brain injury
Michael Mabon
Jeff Mayle
A day in the life of a carer
"Kerry the HATS nurse was my guardian angel"
Don't struggle alone
Harriet Barnsley
I don't want anyone to feel as alone as I did
Amanda Horton
Jeff Clare
A helping hand
Donnie McHarg
Shona Green
Jenny Joppa
Philippa Taylor
Debra Jones
John Dougan
"No memory of the day that changed my life"
Nick Gibbs
Jean Parker
My experience of parenting after brain injury
Sue McIntyre
Daniel Mole
Keely McGhee
Paula Stanford
Jules Pring
Tara Moore
Dr Amy Izycky's Headway Exhibition
Nicola Brown
Rod Maxwell
Joy Webb
Grace Vobe
Doing it the Head way
Carer vacancy. Unpaid. Full time. No experience required.
Joe Sandford
My Brain Injury ID Card
Matthew Nichols
Heather Pollard
Danielle
Noelle Robinson
Giles Hudson
Q&A - ‘Be in the moment. This is all you have.’
Q&A – “I would be the Happiness Fairy, I’ve sprinkled Happy Dust on you, now smile.”
Nature's Way: Gardening after brain injury
The debilitating impact of social isolation
Joanne Wood - Who
David Greer
Lynne O'Grady
Clair Bennett
Danielle's story - returning home
Anne Johnston
Q&A: Cat
How I overcame panic attacks
Q&A with Zalehka Price-Davies
Philippa-Anne Dewhirst
After my brain injury I kept questioning, 'what if I have lost my ability to be creative?'
Chris Bryant
Busting the myths around brain injury and sex
I swear, he knew he was helping me
Hannah Brandon
Keith Poultney
Joanna Darmody
Terry Slade
Tamara Bond
Kavita Basi
Nigel Limb
Learning to live again
David Wheeler
Jessica Stevens
Andrew Plowright
Steve Borland
Tracey Cox
Financial fraud: a risk you can't afford to ignore
Dating after brain injury
Max Muteliso
Q&A: Roger Merriman
Parenting with a brain injury
Ben Clench
Kieran Broadfield
Max Munro
Louise Lane
Adam Nicke - Q&A
Hitting the High Street at Headway's Hinckley shop
Hitting the high street at headway hinckley
London Marathon Runners
Rebecca Hutchings
Joanne Wood
Paws for Thought
Jake Elliott
Growing Together with Headway Cambridgeshire
Lauren Walkington Q&A
Daniel Parslow
Alex Murphy
Matt Masson
Alphabet Brains
Pete Bourne
David Yabbacome
Julie Sadler
Lottie Butler
Candice Ridley
Belinda Medlock
Unravelling the mystery of fatigue
Lara Newson: Head Smash
Robert Courtnell
Hipatia Preis
Stewart Gray
Mary's Story
Hannah O'Dowd
Victoria Wicks
Carol Smith
ABI Week across the UK
Rebecca Ivatts
Nicola Evans
'Writing gives me meaning'
The perils of gambling after brain injury
Fit for purpose: The benefits of being active after brain injury
Festival fun after brain injury
6 strategies for getting back to work after brain injury
Matt Rhodes
Clare Hull
Stop the bus! A guide to public transport
Maria Munn
Brain injury: To tell or not to tell?
5 ways to cope with taste and smell problems after brain injury
The uneasy relationship between alcohol and brain injury
9 ways to help with planning problems after brain injury
7 top tips for managing visual problems after brain injury
10 ways to cope with depression after brain injury
Supporting children: visiting a parent in hospital
Supporting children after a parent's brain injury: when a parent comes home
Donna Siggers
How to manage memory problems after brain injury
Hot weather after brain injury: tips for keeping cool
Stefan Leader
Keith
A picture speaks a thousand words
Andrew Purnell
Ruth Berkoff
Sam Hulse
Katherine McKinstry
Chloé Briffa
Socialising after brain injury
Shane Booth
Theme parks: accessibility after brain injury
William Windle
Ron Gains
Rebecca Jones
Sarah Scott
Pregnancy after brain injury
Music after brain injury
Emma Martins
Dancing after brain injury
Scottie Elliott
Lorna Lancaster
Carol Evans
John Wrathall
Fiona Baker-Holden
Ryan Goodenough
Christmas after brain injury
Cecilia Danielsson
Rik Waddon
Saturday Night Fever
Anthony Hewson
Q&A: Julian Earl
Fireworks after brain injury
Coping with Christmas in hospital
Eleanor Brander
Beccy Young
Veronica Woods
10 things not to say to someone with a brain injury
Tracey Newman
Lauren Gilligan
Louis McGuire
Fighting the bear
David Macdonald
Yvette Lumley
Christina Sweeney
Charlotte Warhurst
Cindy Hollingsworth
Spencer Senior
Q&A: Steven Kelly
Sarah Lane
I am a firm believer in not just speaking of the change, but actively searching to be part of it.
Carwyn Wooldridge
Liz Wilson
Lucy Rogoff
Bryony Wilshaw
David Wozny
Sarah Allwood
Leah Moore
"We're all going on an assisted holiday"
Anne's top tips for self-isolation
Sammy's top tips for managing mental health problems during self-isolation
Kavita's tips for self-isolation
Belinda’s story: Isolation after brain injury
Mikey Smithson
Lucie Bell
Let’s talk continence problems after brain injury
Mark Kennedy
Gary Younge
Mindfulness and me
Life in lockdown: Alison's story
John Beaumont
Catherine Erdal
CinderZ
Lyndsey Anderson
Rock painting by Deborah Johnston
Q&A: Hollie-Blue Huntsman
Donna Davies
Caroline Spiers
Phil Birch
More than my brain injury: Danielle Grant
Brain Injury Sunblock and the Infernal Birdsong
Sandra Liddell
Brain Injury And Covid: Jane Hallard
Brain Injury And Covid: Jean Parker
A day in the life of a Headway helpline consultant
Brain injury and Covid: Tom Harris
Brain Injury And Covid: Michael Perry
Rebekah Nesbitt
The Headway helpline: You're not alone
The price of a punch
David Baker
Donna Harris
7 signs of executive dysfunction after brain injury
My poetry: Joseph McAloon
Angela Lewis
Daniel Sutherland
Andrew Brown
Sarah McGrath
Dan Goldstraw
In her own words: Emma Davey
My poetry: John Marshall
Disinfectant by Sarah-Louise Lennon
Karen Whitehead
Wendy Joss
In his own words: Max Bongard
Karl Hargreaves
Animation: Memory loss after brain injury
How to cope with memory problems after brain injury
Q&A: George Mitchell
Michelle Hay
Q&A: Alan Heal
Lucy Hunter
Cara's story
Q&A: Rosemary Shaw
Mental health and brain injury
Emma Chivers
Q&A: Terence Berritt
Q&A: Emma Linnell
Tai Chi After Brain Injury with Dr Giles Yeates
In her own words: Emma Lindsay
Phillip Cragg
Paintings by Hannah Jenkins
Q&A: Alison Rockall
Alex Danson-Bennett MBE
My poetry: Helen Wilson
Haydn Garrod
Podcast: Life with no filter
Overcoming challenges after brain injury
Creative Expression: Mark and Jules Kennedy
Eleanor Furneaux
Creative Expression: Lucy Pugh
Claire Bullimore
My artwork: Sandra E Ball
Blue Mundane Monday Mix by Glen Stephenson
Nicola Cross
Survival is a Team Dream by Philippa Bateman
Brain Attack Music by Andy Dovey
Top tips for coping with parenting through lockdown
Pauline O'Connor
Duncan Boak
Gill and Terry Oliver
Jelly Brain documentary: A gift to mum
In her own words: Jodie Bacon
Monica Petrosino
Josh Rawson
What triggers anger after brain injury?
Gerald Heffernan
Back behind the wheel: Paula Barlow
Back behind the wheel: Driving FAQs
Elizabeth Wilkins
My poetry: Sam Norris
Alex Richardson
Emerging from lockdown: Tips for brain injury survivors
My podcast by Nikki Webber MBE
Isolation and loneliness: Life with no filter podcast
A life of lockdown? Belinda's story
A life of lockdown? Derek's story
A life of lockdown? Melanie's story
A life of lockdown? Elizabeth's story
Mindfulness Training after Brain Injury with Dr Niels Detert
Fresh Start by the Headway Glasgow Writing Group
'I've Made It!' by Becki York
Lucy O'Donovan
Top tips for coping with headaches
Helena Breslin
Sue Williams
Reflections of Chair-Man Eason
Ceara's story
Tracy Dickson
Julie Mueller
Thomas Leeds
Headaches: The whats, whys and hows
My photography: Rob Dinwoodie
Nick Henderson
Lenka Brunclikova
Emma Doherty
Planting a seed of thought - Natalie Parr
'My Broken Brain' by Sam Hedges
Sally Smith
Catherine Jessop - Pulling Through
Helen Bray
Exploring your dreams
Sweet dreams? Getting a good night's sleep after brain injury
Mindfulness after brain injury
Mike Clark
Amy Streather
Eleanor May Blackburn
Paul Wilkins
Barry Cusack: My body and mind
Our relationship reality: Love after brain injury
Love after brain injury: Thalia and Matt
Tisha's story
Executive dysfunction explained
Let’s talk about sex...
When Catwalks are Barbed
Hope by Angela Webb
Dee Gall
Headway gets creative!
From a child's mind to centre stage
Zoe Rainaki
What did you not see? By Stef Harvey
A Windy Moment by Nick Fletcher
Helen and Liz
The Sound of Recovery
A family united to support life after brain injury
See the Hidden Me: Iona's story
See the Hidden Me: Annette's story
See the Hidden Me: John's story
See the Hidden Me: Christine's story
The Brain Injury Cookbook
Raj Gataora
Marco Gambi: A passion for food
Celebrating 10,000 Brain Injury ID Cards
'Rehabilitation rather than incarceration'
Theresa Malcom
Tim Richens
Visual problems: A closer look
Dusty Zeisberger – 24-hour treadmill challenge
A conversation with... Ian Scott-Logan
Ways to help cope at Christmas: tips for survivors, families, friends, and carers
Lisa
Bryce Bell
World’s first ABI Games a huge success!
Steven Lomas
Memory systems
Stevie Ward
Five Years On by Clare Jones
The Penny Drops
Stephen Evans
Don’t get bitten by the sharks!
Jonathan Hirons
Finding your superpower...
Post-traumatic growth after brain injury
Nick Blackwell
Heads, Hats and Healing: Making and Creating Silver Linings
Nigel and Paula's story
Joseph's story
John's story
How to manage isolation after brain injury
Managing anxiety after brain injury
Simon and Marc's story
Sandi's story
Relearning life skills
"A charity of love"
Dawn, Headway volunteer
Pat Griffiths, Chair of Trustees for Headway Meirionnydd
Creative writing sessions: Laura Bailey
Creative writing sessions: Helen Davies
Nicola Bird Blunt
In her own words: Lynn Boyle
My brother was killed by one punch: Aaron Matcham
Completing my life-long dream of running the Brighton Marathon: Adam Clarke
8 ways to manage a lack of insight after brain injury
How to help someone with a brain injury: Top tips for friends and family
Balance problems after brain injury
Safe travels! Your holiday tips
Early warning signs of fatigue
Keeping your relationship healthy after brain injury
Carers: Try these 4 ways to care for yourself
7 tips for volunteering after brain injury
10 top tips for coping with stress after brain injury
Top 10 tips for staying safe online
In memory of much-loved partner and dad
10 ways to manage anger: tips for brain injury survivors
Managing impulsivity and disinhibition following brain injury
Friends: 5 ways to support someone with a brain injury
Diet after brain injury: Healthy body, healthy mind?
Top tips for a good night's sleep
An awfully big row: Giles Johnson
Jurate Ardour
Dean Osborne
Errol
Iain Millar: Rising from Adversity to Find Purpose on the Golf Course
Finding Hope on the Fairway, Anthony Roberts' Journey of Resilience and Inspiration
Ben Fowler
James Heather
Andy Southey
From one punch victim to Headway Hero: A Half Marathon triumph
Mark Winterbourne
World Mental Health Day
Thanking Our Fundraiser: Sahara Trek Triumphm
Sisters’ challenge inspired by ‘hero’ sibling’s brain injury
Ed Dunford
The devastating consequences of one punch
Get to know – Jen, Director of Fundraising
Putting the ‘I’ in identity after brain injury
Coping with winter blues
Making returning to work, work for you
Alan's story
Get to know – Sarah, Trust and Foundations Manager
Give up, or focus tremendously on rehabilitation
What really counts?
Laura Macfarlane
The role art can play in positive change
World Poetry Day
Poem: TBI Survivor
Adapting to life after brain injury: Returning to work
Meet the volunteer - Roger Beattie
We are family! Siblings run for Headway in support of their mum
The impact of brain injury on a family
A craniotomy – ‘the last resort’
David's story A Life Re-written
Andrew's story A Life Re-written
Alison's story A Life Re-written
Liz and Justina's story A Life Re-written
Amnesia and identity
Belfast Marathon
Don't ignore the warning signs
Dr Roger Weddell
Helen Shaw – Headway South Cumbria
Trevor Hall – Headway Hartlepool
Alan McKnight - Finaghy volunteer
A company-wide charity day in aid of Headway
My pain monster
Inspirational brain injury advocate Dr. Bruce Powell Joins Headway Charity Golf Day
The Aphasia Theatre Group
Caolan McCormick
Liam Hamilton
Let's go on holiday!
Lasting Power of Attorney
Peter's 3D model
Headaches after brain injury: tips for Pain Awareness Month
A journey from brain injury to the golf course with Headway
Headway Cardiff's 1920s-inspired silent movie
Author and brain tumour survivor has over 475,000 Facebook followers
UK-based award-winning insurance company, Hastings Direct, steps forward for Headway
Georgina's story
Shopping without the stress after brain injury
Connecting with nature after brain injury
Martin’s Journey: Overcoming Intracranial Subdural Empyema
Drained by fatigue? Try these 8 ways to cope after brain injury
Menopause after brain injury
Hosting or attending an event
Elle's story: Life beyond post-concussion
Steve Lightly
Ataxia after brain injury
The benefits of singing for brain injury survivors
Concussion, head impacts and brain blood vessel function Q&A
10 reasons why you should join Eden's team in the Great North Swim
Being seen and accepted after brain injury
The Waiting Room a short film created by Headway Newtonabbey
Lorna's story On a good day
Raj's story On a good day
Katie's story On a good day
Q&A with Amarachi Nwaneri
Matt: Headway Derby
Celebrating Volunteers’ Week at Headway
Deborah Johnston
Eli's story
When Funding Fails case study: A Headway charity in the West Midlands
When Funding Fails case study: A Headway charity in the South of England
Mark’s story
Charlie’s epic motorbike challenge
A daughter’s brain injury survival story: A mother’s perspective
Morgan had to relearn how to walk when her brain swelled to life-threatening size
Using AI after brain injury: From sci-fi to support
7 strategies to manage your mental health after brain injury
Project 74: Sam King's ultra marathon challenge for his mum
Jaden's story
Fatigue after brain injury: Fighting the winter slump
Back to Go by Leonard Lewis
'Half my head was missing': London CEO shares lifechanging brain injury journey in inspiring TEDx Talk
Adam Billic
Daughter to run London Marathon in late mum's trainers in poignant tribute after losing her to brain injury
Imogen's story
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Headway News spring 2026
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About brain injury
Individuals
Types of brain injury
Hypoxic and anoxic bra...
For individuals
Types of brain injury
Brain aneurysm
Brain bleed (Brain haemorrhage)
Brain tumour
Carbon monoxide poisoning
Concussion
Encephalitis
Hypoxic and anoxic brain injury
Hydrocephalus
Meningitis
Stroke
Traumatic brain injury (TBI)
What happens in a TBI?
How severe is the brain injury?
Effects of brain injury
Behavioural effects of brain injury
Cognitive effects of brain injury
Communication problems
Language impairment (aphasia)
Speech difficulties
Cognitive communication difficulties
Emotional effects of brain injury
Executive dysfunction
Fatigue after brain injury
Hormonal imbalances
Memory problems
Physical effects of brain injury
Post-traumatic amnesia
Hospital treatment and early recovery
At the hospital after brain injury
Early rehabilitation after brain injury
Discharge from hospital after brain injury
How to support a family dealing with brain injury
Coma and prolonged disorders or consciousness (PDOC)
Glasgow Coma Scale
Coma - frequently asked questions
Rehabilitation and continuing care
Rehabilitation
The rehabilitation team
Continuing care
Self-directed support
What is self-directed support?
How to get self-directed support
Making a support plan
Managing your support
Further help with self-directed support
Practical issues
Safeguarding information
Driving after brain injury
Returning to work after brain injury
Returning to education
Holidays and travel
Support through the cost-of-living crisis
Navigating the Cost of Living
Welfare benefits
Appealing a welfare benefits decision
Attendance Allowance
Carer's Allowance
Employment and Support Allowance (ESA)
Personal Independence Payment (PIP)
Preparing for welfare benefits assessments
Statutory Sick Pay
Tips for completing benefits application forms
Universal Credit
Relationships after brain injury
How brain injury affects relationships
Sex and sexuality
How brain injury affects friendships
Parenting and supporting children
How brain injury affects partners
Caring
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Hypoxic brain injury
Hypoxic and anoxic brain injury
The brain needs a continuous supply of oxygen to survive. If the oxygen supply is interrupted, the functioning of the brain is disturbed immediately and irreversible damage can quickly follow. This is known as hypoxic or anoxic brain injury.
The information on this page will be particularly useful for the family members of people who have sustained such an injury and also provides a useful starting point for professionals who wish to improve their knowledge of the subject.
All the technical terms that are used are highlighted in bold and explained on the
Common brain injury terms
page.
In this section:
What is hypoxic brain injury / anoxic brain injury?
What causes hypoxic/anoxic brain injury?
How is hypoxic/anoxic brain injury treated?
What are the outcomes of hypoxic/anoxic brain injury?
Rehabilitation of hypoxic/anoxic brain injury
What are the initial effects of hypoxic/anoxic brain injury?
What are the long-term effects of hypoxic/anoxic brain injury?
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What is hypoxic brain injury / anoxic brain injury?
Oxygen is needed for the brain to make use of glucose, its major energy source. If the oxygen supply is interrupted, consciousness will be lost within 15 seconds and damage to the brain begins to occur after about four minutes without oxygen.
A complete interruption of the supply of oxygen to the brain is referred to as
cerebral anoxia
. If there is still a partial supply of oxygen, but at a level which is inadequate to maintain normal brain function, this is known as
cerebral hypoxia
. In practice, these two terms tend to be used interchangeably.
For the purposes of consistency, this section of the website will use the terms anoxic brain injury or cerebral anoxia, unless hypoxic injury is specifically meant.
What causes hypoxic/anoxic brain injury?
There are many potential causes of cerebral anoxia, including:
Cardiac or respiratory arrest
Irregular heart rhythm or poor function of the heart muscle after a heart attack, resulting in inefficient supply of blood to the brain
Very low blood pressure (shock), resulting from blood loss (haemorrhage) or disturbed heart function
Suffocation
Choking
Strangulation
Very severe asthma attack
Complication of general anaesthesia (where there has been inadequate oxygen supply or cardiac arrest)
Near drowning
Exposure to high altitudes
Smoke inhalation
Carbon monoxide inhalation
Poisoning
Drug overdose
Electric shock
How is hypoxic/anoxic brain injury treated?
The diagnosis of an anoxic brain injury is usually quite clear at an early stage from the details of what has happened and the patient's condition on arrival at hospital. Due to the wide variety of causes of anoxia, immediate treatment will depend on the particular circumstances. In all cases, efforts will be directed at restoring a normal heartbeat, blood pressure and a good supply of oxygen to the brain.
Patients who have suffered a serious anoxic episode will usually be admitted to an
intensive care unit
and put on a ventilator, preferably in a specialist neurosciences centre. The patient may need drugs to maintain adequate blood pressure and normal heart beat. Seizures are quite common after an anoxic brain injury and they can be prolonged and sometimes difficult to bring under control. This is a stage of critical illness and the full range of intensive care support is needed to give the best chances of survival and the best possible outcome.
In some centres, patients may undergo medically induced cooling, referred to as
therapeutic hypothermia
. There is some evidence that this may have a protective effect on the brain and aid recovery by decreasing the oxygen and energy requirements of brain cells. It has been suggested that the protective effect of cooling the brain may be one reason why people sometimes survive after surprisingly long periods of immersion in very cold water. However, although therapeutic hypothermia has been known about for many years, it is still an area of controversy and can produce problems of its own, such as increased risk of infection or interference with blood clotting.
What are the outcomes of hypoxic/anoxic brain injury?
The family will want to know about the time scale of recovery after cerebral anoxia and the point at which further significant improvement becomes unlikely. As with any kind of acquired brain injury, it is difficult to give definitive rules about this.
There is some evidence that the outcome for a severe anoxic brain injury may be poorer than for a
traumatic brain injury
of equivalent severity, as assessed by the
Glasgow Coma Scale
(GCS). This may well be because of differences in the nature of the damage to the brain. In traumatic brain injury, damage to the
axons
(the projections that transmit messages between brain cells) is usually a prominent feature and the brain can often create alternative connections to compensate for this. In anoxic brain injury, the actual
nerve cell bodies
themselves are very vulnerable to damage and this damage is irreparable.
A number of factors can help to predict the outcome after cerebral anoxia:
Age
As with other forms of acquired brain injury, people over the age of 50 years tend to do less well overall than younger ones, both in terms of how likely they are to survive in the first place and in the degree of long-term recovery. However, there is evidence that older people are able to benefit from rehabilitation programmes after cerebral anoxia and so deserve equally vigorous efforts to achieve the best possible outcome.
Duration of the anoxic episode
The outcome will be determined by how extensive the damage to the brain has been. This will depend on the length of time the brain was deprived of oxygen, which can often be estimated from information about what has happened. For example, it may be known that it took 15 minutes to restore a normal heart beat after a cardiac arrest, or that someone was immersed in a swimming pool for six minutes in a near drowning incident.
Duration of coma
The duration of unconsciousness after an anoxic episode reflects the severity of the injury to the brain and helps predict the outcome. This has been studied in most detail after cardiac arrest and it has been found that only about 12% of patients who have been comatose for more than six hours after a cardiac arrest make a good recovery.
It should be noted that some comas are medically induced in order to protect the brain from further damage. The duration of a medically induced coma does not give an indication of the outcome.
Pupil reaction
Normally, the pupils will constrict when a bright light is shone into the eyes. However, following brain injury, this reflex may be lost, causing the pupils to become dilated and fixed, no longer reacting to light. This is an unfavourable sign following an anoxic brain injury and indicates a disturbance in the function of the
brainstem
Electroencephalogram (EEG)
The EEG displays the electrical activity of the brain, recorded from a set of small metal disc electrodes placed on the scalp.
There has been a good deal of research on the EEG following cardiac arrest and the degree of EEG abnormality does have some value in helping to predict the outcome. This works best at the extremes. People with a normal EEG in the early stages after cardiac arrest have a very good chance of making a full recovery and those with profoundly abnormal EEGs often either do not survive at all, or will have severe disabilities. However, there is a large group who have intermediate degrees of EEG abnormality, where the outcome is less predictable.
Brain imaging
Computed Tomography
(CT) and
Magnetic Resonance Imaging
(MRI) can show if there is brain swelling and give an indication of the degree of damage to the brain and the areas affected. This can help in predicting the outcome and trying to anticipate what level of neurological disability is likely in the event of survival. However, brain scans may show very little in some patients and what they show depends on the nature of the brain injury and the interval between the anoxic episode and the scan.
It is worth noting that, while there are other kinds of brain scanning techniques, such as Positron Emission Tomography (PET), functional Magnetic Resonance Imaging (fMRI), Single Photon Emission Computed Tomography (SPECT) and Magnetoencephalography (MEG), they are not usually available in hospitals and have little or no value in the assessment of brain injury. They are mainly used for research purposes.
Somatosensory evoked potentials (SSEPs)
SSEPs
are the electrical responses of the brain to stimulation of the senses. They can normally be recorded from the scalp, following electrical stimulation of nerves at the wrist. These nerves transmit sensation from the arm to the brain. The absence of SSEPs recorded from the scalp is associated with a poor outcome.
Rehabilitation of hypoxic/anoxic brain injury
The principles of
rehabilitation
after cerebral anoxia are the same as for other types of acquired brain injury. The goal is to provide support from an integrated team with a range of specialist skills, able to help with the different problems which may occur and to support each individual to achieve the best possible outcome.
The outlook for anoxic brain injury can be uncertain and different specialists have expressed quite varied views on the timescale of recovery, based on their own individual experiences. Good improvement within the first month after an anoxic episode suggests that the outcome may be more favourable.
The most rapid recovery is usually in the first six months, and by about one year the likely long-term outcome will have become clearer. However, improvement may continue for much longer after brain injury, certainly for several years, although the steps may become more modest and gradual after the first few months. Adequate rehabilitation from the
earliest possible stage
is vital in order to achieve the best outcome.
What are the initial effects of hypoxic/anoxic brain injury?
The effects of hypoxic or anoxic brain injury, where the brain is starved of oxygen, can range from mild, short-term symptoms such as dizziness or concentration problems, through to severe, long-term issues including vision, speech and memory.
The body will respond to cerebral anoxia by increasing blood flow to the brain in an attempt to restore an adequate supply of oxygen. However, it is only possible to increase brain blood flow to about twice the normal level. If this is not enough to compensate for the anoxia, brain function will be disturbed and symptoms will become apparent.
Mild hypoxic/anoxic brain injury
If the cerebral anoxia is mild, there will be problems with concentration, attention, co-ordination and short-term memory, which may be relatively subtle to begin with. There may be headache, light-headedness, dizziness, an increase in breathing rate and sweating. There can be a restriction in the field of vision, a sensation of numbness or tingling and feelings of euphoria.
Severe hypoxic/anoxic brain injury
As the degree of anoxia becomes more pronounced, confusion, agitation or drowsiness appear, along with
cyanosis
- a bluish tinge to the skin, reflecting the lowered oxygen content of the blood, often most apparent around the lips, mouth and fingertips. There may be brief jerks of the limbs (
myoclonus
) and seizures, both resulting from the damaging effects of lack of oxygen on the brain. If the anoxia is severe, it will result in loss of consciousness and coma.
Because of their high demand for energy, the nerve cells of the brain are particularly sensitive to lack of oxygen. Although anoxia may produce damage to cells throughout the brain, some areas are more vulnerable than others. The
cerebral cortex
(especially the
parietal lobes
and
occipital lobes
), the
hippocampus
(important in memory), the
basal ganglia
and the
cerebellum
(both contributing to the control of movement) are particularly sensitive to anoxia.
When there is also an interruption of blood flow, as after a cardiac arrest, this may lead to damage in the areas furthest away from the territories supplied by the three major arteries of the brain. These '
watershed areas
' are particularly vulnerable when blood flow is reduced and may suffer death of tissue (
infarction
), like that occurring in a
stroke
Severe anoxic brain injury may occasionally cause damage to the
hypothalamus and
pituitary gland
, which are small structures at the base of the brain responsible for regulating the body's hormones. Damage to these areas can lead to insufficient or increased release of one or more hormones, which causes disruption of the body's ability to maintain a stable internal environment (
homeostasis
). In the early stages this can cause a condition called
neurogenic diabetes insipidus
, which is characterised by increased thirst and excessive production of dilute urine. This is due to a reduction in secretion of a hormone called vasopressin (anti-diuretic hormone) and can be treated by administering desmopressin (manufactured anti-diuretic hormone) and replacing lost fluids.
Cerebral anoxia may also produce brain swelling and this can add to the damage, by squeezing off smaller blood vessels and interrupting the local blood supply.
Reduced awareness states
If there has been very severe anoxic damage to the brain, there may be a transition from
coma into a
persistent vegetative state (PVS)
. In PVS the basic brain functions of breathing spontaneously, maintaining the heartbeat and blood pressure, digesting food and producing urine all continue. However, even though there may still be a cycle of sleeping and waking and the eyes may open spontaneously, there is no real evidence of consciousness in any meaningful sense and no response to what is going on in the environment.
More recently, the possibility of a
minimally conscious state
has been recognised. This is distinct from PVS, because although it is still a state of profoundly altered consciousness, there is minimal but definite evidence of some limited self-awareness or awareness of the surroundings.
Severe anoxic brain injury is often fatal. In cases where the injury is so severe that there is no chance of recovery doctors may put in place orders that the patient is not resuscitated in the event of further complications, such as cardiac arrest.
What are the long-term effects of hypoxic/anoxic brain injury?
The long-term consequences will depend on the severity of the cerebral anoxia and on how much irreversible damage has occurred in the brain. If there has only been mild or short-lived anoxia, there may well be recovery back to a normal or near normal level of functioning.
However, if the anoxic injury has been more marked the outcome is less certain and there are likely to be long-term effects. The nature of these problems will vary from person to person, depending on the severity of the injury and the brain areas affected.
There is considerable overlap with the
effects of other kinds of acquired brain injury
. However, the selective vulnerability of particular regions of the brain to anoxia also gives some distinctive features to this type of injury. A wide range of difficulties can occur, although not all are necessarily seen in every individual.
Physical effects
Damage to the
cerebral cortex
, the
cerebellum
and the
basal ganglia
may lead to limb weakness and disturbances of movement, balance and co-ordination. There may be spasticity or rigidity, with increased muscle tone. Anoxic injury to the basal ganglia may lead to abnormal movements, including tremor, involuntary writhing movements (
athetosis
) and brief, jerky movements (
chorea
).
Visual disorders
The
occipital lobe
at the back of the brain contains the main visual centres and it is particularly susceptible to anoxia, which may cause a loss of visual function referred to as cortical blindness. Damage to the occipital lobe may also lead to conditions such as
Anton's
syndrome
. This is a rare condition, in which a patient with cortical blindness may show no awareness of the loss of vision and deny any problem, despite walking into things and showing obvious evidence of an inability to see normally. Conversely, patients may experience
blindsight
, in which they may respond to visual stimuli without being consciously aware of being able to see.
Memory problems
The
hippocampus
, on the inner surface of the temporal lobe, is an important structure for memory function and it is sensitive to anoxic injury. Memory problems are very common following cerebral anoxia and they may be quite severe.
Speech and language
Disturbances of speech and language function may occur because of damage to areas of the brain involved in the production and articulation of speech, finding the right words and understanding language. Spoken and written communication may both be affected.
Executive dysfunction
Damage to the
frontal lobes
may lead to disturbances in
executive function
- the ability to think and reason, to synthesize and integrate complex information and make considered judgements and decisions about what to do in a particular situation. These skills underlie the ability to plan for the future in a sensible way, as well as to function effectively in work and social settings.
Emotional
and
behavioural changes
Frontal lobe injury may produce changes in personality, including irritability, poor tolerance of frustration, impulsiveness and impairments in social perception and conduct. There may be apathy and lack of insight, as well as intermittent agitation and mood swings, or more sustained periods of depression. These changes may slow the progress of rehabilitation and make it difficult to achieve a successful return home.
Hormonal imbalances
Occasionally, severe anoxic injury can cause damage to the hypothalamus or pituitary gland, which can lead to a variety of hormonal problems, such as
hypopituitarism
. This is caused by a reduction in the release of hormones by the
pituitary gland
and symptoms include excessive tiredness, muscle weakness, decreased sex drive, inability to regulate body temperature, weight gain, low blood pressure, dry skin and headaches. Hormone replacement therapy can be used to treat hypopituitarism and other related disorders.
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Explore the Supporting you section to find out how we can help.
My story
Smart by name...
In January 2009, when she was just 16, Lizzie Smart was struck down by an infection in her throat, causing her brain to be starved of oxygen. But this determined young lady is not one to let anything stand in the way of her dreams.
Read story
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My poetry: John Marshall
Disinfectant by Sarah-Louise Lennon
Karen Whitehead
Wendy Joss
In his own words: Max Bongard
Karl Hargreaves
Animation: Memory loss after brain injury
How to cope with memory problems after brain injury
Q&A: George Mitchell
Michelle Hay
Q&A: Alan Heal
Lucy Hunter
Cara's story
Q&A: Rosemary Shaw
Mental health and brain injury
Emma Chivers
Q&A: Terence Berritt
Q&A: Emma Linnell
Tai Chi After Brain Injury with Dr Giles Yeates
In her own words: Emma Lindsay
Phillip Cragg
Paintings by Hannah Jenkins
Q&A: Alison Rockall
Alex Danson-Bennett MBE
My poetry: Helen Wilson
Haydn Garrod
Podcast: Life with no filter
Overcoming challenges after brain injury
Creative Expression: Mark and Jules Kennedy
Eleanor Furneaux
Creative Expression: Lucy Pugh
Claire Bullimore
My artwork: Sandra E Ball
Blue Mundane Monday Mix by Glen Stephenson
Nicola Cross
Survival is a Team Dream by Philippa Bateman
Brain Attack Music by Andy Dovey
Top tips for coping with parenting through lockdown
Pauline O'Connor
Duncan Boak
Gill and Terry Oliver
Jelly Brain documentary: A gift to mum
In her own words: Jodie Bacon
Monica Petrosino
Josh Rawson
What triggers anger after brain injury?
Gerald Heffernan
Back behind the wheel: Paula Barlow
Back behind the wheel: Driving FAQs
Elizabeth Wilkins
My poetry: Sam Norris
Alex Richardson
Emerging from lockdown: Tips for brain injury survivors
My podcast by Nikki Webber MBE
Isolation and loneliness: Life with no filter podcast
A life of lockdown? Belinda's story
A life of lockdown? Derek's story
A life of lockdown? Melanie's story
A life of lockdown? Elizabeth's story
Mindfulness Training after Brain Injury with Dr Niels Detert
Fresh Start by the Headway Glasgow Writing Group
'I've Made It!' by Becki York
Lucy O'Donovan
Top tips for coping with headaches
Helena Breslin
Sue Williams
Reflections of Chair-Man Eason
Ceara's story
Tracy Dickson
Julie Mueller
Thomas Leeds
Headaches: The whats, whys and hows
My photography: Rob Dinwoodie
Nick Henderson
Lenka Brunclikova
Emma Doherty
Planting a seed of thought - Natalie Parr
'My Broken Brain' by Sam Hedges
Sally Smith
Catherine Jessop - Pulling Through
Helen Bray
Exploring your dreams
Sweet dreams? Getting a good night's sleep after brain injury
Mindfulness after brain injury
Mike Clark
Amy Streather
Eleanor May Blackburn
Paul Wilkins
Barry Cusack: My body and mind
Our relationship reality: Love after brain injury
Love after brain injury: Thalia and Matt
Tisha's story
Executive dysfunction explained
Let’s talk about sex...
When Catwalks are Barbed
Hope by Angela Webb
Dee Gall
Headway gets creative!
From a child's mind to centre stage
Zoe Rainaki
What did you not see? By Stef Harvey
A Windy Moment by Nick Fletcher
Helen and Liz
The Sound of Recovery
A family united to support life after brain injury
See the Hidden Me: Iona's story
See the Hidden Me: Annette's story
See the Hidden Me: John's story
See the Hidden Me: Christine's story
The Brain Injury Cookbook
Raj Gataora
Marco Gambi: A passion for food
Celebrating 10,000 Brain Injury ID Cards
'Rehabilitation rather than incarceration'
Theresa Malcom
Tim Richens
Visual problems: A closer look
Dusty Zeisberger – 24-hour treadmill challenge
A conversation with... Ian Scott-Logan
Ways to help cope at Christmas: tips for survivors, families, friends, and carers
Lisa
Bryce Bell
World’s first ABI Games a huge success!
Steven Lomas
Memory systems
Stevie Ward
Five Years On by Clare Jones
The Penny Drops
Stephen Evans
Don’t get bitten by the sharks!
Jonathan Hirons
Finding your superpower...
Post-traumatic growth after brain injury
Nick Blackwell
Heads, Hats and Healing: Making and Creating Silver Linings
Nigel and Paula's story
Joseph's story
John's story
How to manage isolation after brain injury
Managing anxiety after brain injury
Simon and Marc's story
Sandi's story
Relearning life skills
"A charity of love"
Dawn, Headway volunteer
Pat Griffiths, Chair of Trustees for Headway Meirionnydd
Creative writing sessions: Laura Bailey
Creative writing sessions: Helen Davies
Nicola Bird Blunt
In her own words: Lynn Boyle
My brother was killed by one punch: Aaron Matcham
Completing my life-long dream of running the Brighton Marathon: Adam Clarke
8 ways to manage a lack of insight after brain injury
How to help someone with a brain injury: Top tips for friends and family
Balance problems after brain injury
Safe travels! Your holiday tips
Early warning signs of fatigue
Keeping your relationship healthy after brain injury
Carers: Try these 4 ways to care for yourself
7 tips for volunteering after brain injury
10 top tips for coping with stress after brain injury
Top 10 tips for staying safe online
In memory of much-loved partner and dad
10 ways to manage anger: tips for brain injury survivors
Managing impulsivity and disinhibition following brain injury
Friends: 5 ways to support someone with a brain injury
Diet after brain injury: Healthy body, healthy mind?
Top tips for a good night's sleep
An awfully big row: Giles Johnson
Jurate Ardour
Dean Osborne
Errol
Iain Millar: Rising from Adversity to Find Purpose on the Golf Course
Finding Hope on the Fairway, Anthony Roberts' Journey of Resilience and Inspiration
Ben Fowler
James Heather
Andy Southey
From one punch victim to Headway Hero: A Half Marathon triumph
Mark Winterbourne
World Mental Health Day
Thanking Our Fundraiser: Sahara Trek Triumphm
Sisters’ challenge inspired by ‘hero’ sibling’s brain injury
Ed Dunford
The devastating consequences of one punch
Get to know – Jen, Director of Fundraising
Putting the ‘I’ in identity after brain injury
Coping with winter blues
Making returning to work, work for you
Alan's story
Get to know – Sarah, Trust and Foundations Manager
Give up, or focus tremendously on rehabilitation
What really counts?
Laura Macfarlane
The role art can play in positive change
World Poetry Day
Poem: TBI Survivor
Adapting to life after brain injury: Returning to work
Meet the volunteer - Roger Beattie
We are family! Siblings run for Headway in support of their mum
The impact of brain injury on a family
A craniotomy – ‘the last resort’
David's story A Life Re-written
Andrew's story A Life Re-written
Alison's story A Life Re-written
Liz and Justina's story A Life Re-written
Amnesia and identity
Belfast Marathon
Don't ignore the warning signs
Dr Roger Weddell
Helen Shaw – Headway South Cumbria
Trevor Hall – Headway Hartlepool
Alan McKnight - Finaghy volunteer
A company-wide charity day in aid of Headway
My pain monster
Inspirational brain injury advocate Dr. Bruce Powell Joins Headway Charity Golf Day
The Aphasia Theatre Group
Caolan McCormick
Liam Hamilton
Let's go on holiday!
Lasting Power of Attorney
Peter's 3D model
Headaches after brain injury: tips for Pain Awareness Month
A journey from brain injury to the golf course with Headway
Headway Cardiff's 1920s-inspired silent movie
Author and brain tumour survivor has over 475,000 Facebook followers
UK-based award-winning insurance company, Hastings Direct, steps forward for Headway
Georgina's story
Shopping without the stress after brain injury
Connecting with nature after brain injury
Martin’s Journey: Overcoming Intracranial Subdural Empyema
Drained by fatigue? Try these 8 ways to cope after brain injury
Menopause after brain injury
Hosting or attending an event
Elle's story: Life beyond post-concussion
Steve Lightly
Ataxia after brain injury
The benefits of singing for brain injury survivors
Concussion, head impacts and brain blood vessel function Q&A
10 reasons why you should join Eden's team in the Great North Swim
Being seen and accepted after brain injury
The Waiting Room a short film created by Headway Newtonabbey
Lorna's story On a good day
Raj's story On a good day
Katie's story On a good day
Q&A with Amarachi Nwaneri
Matt: Headway Derby
Celebrating Volunteers’ Week at Headway
Deborah Johnston
Eli's story
When Funding Fails case study: A Headway charity in the West Midlands
When Funding Fails case study: A Headway charity in the South of England
Mark’s story
Charlie’s epic motorbike challenge
A daughter’s brain injury survival story: A mother’s perspective
Morgan had to relearn how to walk when her brain swelled to life-threatening size
Using AI after brain injury: From sci-fi to support
7 strategies to manage your mental health after brain injury
Project 74: Sam King's ultra marathon challenge for his mum
Jaden's story
Fatigue after brain injury: Fighting the winter slump
Back to Go by Leonard Lewis
'Half my head was missing': London CEO shares lifechanging brain injury journey in inspiring TEDx Talk
Adam Billic
Daughter to run London Marathon in late mum's trainers in poignant tribute after losing her to brain injury
Imogen's story
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