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Hypoxic-ischemic encephalopathy (HIE) specifically refers to brain damage that occurs when there is insufficient oxygen (hypoxia) and blood flow (ischemia) to the brain. This condition often arises in situations such as cardiac arrest, severe respiratory failure, or during an obstructed delivery in newborns.

The lack of oxygen disrupts the critical cellular processes necessary for normal brain function, leading to neuronal injury and, if prolonged, cell death. The term succinctly captures the dual aspects of injury: hypoxia resulting from low oxygen levels and ischemia caused by reduced blood flow.

In the context of this question, the other options do not capture the primary cause of HIE. Inflammation, high blood pressure, or toxic substances may lead to brain injury but are not the primary mechanisms involved in hypoxic-ischemic encephalopathy. Instead, this condition exclusively results from the combination of inadequate oxygen delivery and compromised perfusion to the brain.