![]() More profound anoxia affecting the cortex, basal ganglia, and brainstem results in coma and subsequent death. ![]() Widespread necrosis of the cortex with the brainstem intact produces a vegetative state. Pyramidal cells in the hippocampus, Purkinje cells of the cerebellum, and pyramidal cells of the third and fifth layers of the cerebral cortex are vulnerable to even moderate degrees of anoxia. ![]() Neurons survive only for minutes after the oxygen supply is reduced below critical levels. Other organs, such as the kidney and heart, can tolerate ischemic periods of up to thirty minutes, but the brain can tolerate no more than a few minutes of anoxia. Anoxic brain injury is extremely complex in nature and consists of a variety of insults to cells that involve decreased oxygen availability, systemic acidosis, hypercapnia, and sometimes superimposed ischemia. The term cerebral anoxia indicates any form of inadequate oxygen delivery to the brain, including hypoxemia and ischemia.
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