Sepsis-associated encephalopathy

Gofton, Teneille; Young, G. Bryan

doi:10.1038/nrneurol.2012.183

Cited by 581 publications

(573 citation statements)

References 77 publications

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“…According to document, the patients with minor SAE may show mental or behavioral changes, severe SAE patients may also be presented with non-convulsive seizures, lethargy, or even coma. Moreover, there was no clinical and laboratory evidence of direct infection of the central nervous system, or any other reasons can be identified encephalopathy [21,22]. In fact, SAE is not uncommon, which has brain dysfunction as an onset or an isolated manifestation, and its initial manifestation may be a mild mental or behavioral changes, including hallucinations, irritability, delirium, inappropriate behavior, and so forth [21,22].…”

Section: Discussionmentioning

confidence: 99%

Initial Presenting as Acute Vertigo Syndrome in Sepsis Associated Encephalopathy: A Retrospective Case Series

Tong¹

2017

SOJN

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Objective: To investigate whether sepsis associated encephalopathy (SAE) is a cause of acute vertigo syndrome (AVS). Methods:From Jen 2014 to Des 2016 period, the clinical data in 7 patients who were from a hospital intensive care unit (ICU), because of misdiagnosed SAE whose complaint was vertigo or dizziness, was retrospectively analyzed.Results: Among 7 misdiagnosed SAE patients, 5 were male and 2 were female, with a median age of 60 years (range, 23-82 years). All patients presented with AVS at onset. Of them, transient or recurrent AVS occurred in 6 patients, and persistent AVS in 1case. 3 patients by brain angiography showed the ischemic lesions in the central vestibular partway, however, all of 7 cases with AVS presented a central vestibular impaired mechanism from septic shock or sepsis, supporting AVS was a central AVS. The patient 1 only presented isolated central AVS and with no others brain dysfunction, so met the diagnosis of mild SAE, and with a favorable prognosis. The other 6 cases developed from mild brain dysfunction (central AVS) to deep coma and multiple organ failure, met the diagnosis of severe SAE with multiple organ failure, and all of them died eventually.Conclusions: SAE might be a little-known cause of the central AVS. A recognition of this issue facilitate earlier identification and more timely treatment in patients with AVS with SAE.

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Section: Discussionmentioning

confidence: 99%

Initial Presenting as Acute Vertigo Syndrome in Sepsis Associated Encephalopathy: A Retrospective Case Series

Tong¹

2017

SOJN

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“…11,42 Degradation of the basal lamina in brain tissue often results in BBB leakage, edema, and hemorrhage, and MMP-9 levels are considered markers of poor prognosis in brain ischemia. 43 Although there is evidence that BBB is affected in septic patients 44 and it is thought to contribute to development and progression of septic-associated encephalopathy, 45 mechanisms of BBB damage in sepsis have been poorly explored. Dal-Pizzol et al 46 reported that the increase of BBB permeability in septic rats is time-related to the increase of MMP-9 and MMP-2 in the microvessels, and this effect was reversed by MMPs inhibitors.…”

Section: Discussionmentioning

confidence: 99%

Endotoxin-induced lung alveolar cell injury causes brain cell damage

Rodríguez-González

Ramos-Nuez

Martin‐Barrasa

et al. 2014

Exp Biol Med (Maywood)

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Sepsis is the most common cause of acute respiratory distress syndrome, a severe lung inflammatory disorder with an elevated morbidity and mortality. Sepsis and acute respiratory distress syndrome involve the release of inflammatory mediators to the systemic circulation, propagating the cellular and molecular response and affecting distal organs, including the brain. Since it has been reported that sepsis and acute respiratory distress syndrome contribute to brain dysfunction, we investigated the brain-lung crosstalk using a combined experimental in vitro airway epithelial and brain cell injury model. Conditioned medium collected from an in vitro lipopolysaccharide-induced airway epithelial cell injury model using human A549 alveolar cells was subsequently added at increasing concentrations (no conditioned, 2%, 5%, 10%, 15%, 25%, and 50%) to a rat mixed brain cell culture containing both astrocytes and neurons. Samples from culture media and cells from mixed brain cultures were collected before treatment, and at 6 and 24 h for analysis. Conditioned medium at 15% significantly increased apoptosis in brain cell cultures 24 h after treatment, whereas 25% and 50% significantly increased both necrosis and apoptosis. Levels of brain damage markers S100 calcium binding protein B and neuron-specific enolase, interleukin-6, macrophage inflammatory protein-2, as well as matrix metalloproteinase-9 increased significantly after treating brain cells with !2% conditioned medium. Our findings demonstrated that human epithelial pulmonary cells stimulated with bacterial lipopolysaccharide release inflammatory mediators that are able to induce a translational clinically relevant and harmful response in brain cells. These results support a brain-lung crosstalk during sepsis and sepsis-induced acute respiratory distress syndrome.

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“…Szacuje się, że encefalopatia septyczna jest najczęstszą przyczyną majaczenia w stanach nagłych i dotyka 8-70% pacjentów z uogólnioną infekcją [4]. Sepsa jest najczęstszą przyczyną przyjęć na oddziały intensywnej terapii (OIT), natomiast SAE/ SAD to bardzo często spotykane patologie u ciężko chorych pacjentów.…”

Section: Epidemiologiaunclassified

“…Badanie EEG może być pomocne, gdy trzeba wykluczyć nienapadowy stan padaczkowy u krytycznie chorego pacjenta [14].…”

Section: Elektroencefalografiaunclassified

Encefalopatia septyczna a majaczenie stanu ciężkiego

Kotfis

2018

Pomeranian J Life Sci

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Introduction: Sepsis-associated encephalopathy is an acute dysfunction of the central nervous system (CNS) that arises as a consequence of generalized systemic infection, yet without brain infection. The aim of this review is to introduce septic encephalopathy as a disease, with all of the epidemiology data, diagnostic opportunities, pathophysiology and possible treatment. Sepsis-associated encephalopathy is a medical condition characterized by a broad spectrum of disturbances of consciousness, from delirium to coma, with possible seizures or focal neurological signs. Many pathophysiological mechanisms lie at the basis of septic encephalopathy, including inflammation or dysfunction of cerebral perfusion. Another important mechanism includes interactions between inflammatory cytokines and acetylcholine that lead to abnormal cholinergic transmission and neuronal death. Moreover, interaction between acetylcholine and inflammatory cytokines may induce immunosuppression. Sepsis-associated encephalopathy diagnosis is strictly clinical, based on neurological examination and the exclusion of other causes, because there are no definite biochemical tests or radiological studies specific for this disease. The use of ICU delirium screening tools, such as CAM-ICU (Confusion Assessment Method for the Intensive Care Unit) enables earlier detection of brain dysfunction. Neuroimaging studies (computed tomography, magnetic resonance imaging), as well as electroencephalograhy may be helpful in the assessment of the severity of dysfunction. The most important element is early diagnosis of sepsis, especially with the use of the QuickSOFA scale, and early initiation of multidirectional treatment according to Surviving Sepsis Campaign guidelines: early source identification and source control, initiation of optimal antibiotic therapy, adequate fluid therapy and supportive treatment for major organs. In order to prevent CNS dysfunction in the ICU, deep sedation and benzodiazepines should be avoided and dexmedetomidine and propofol introduced instead. Pharmacological treatment of ICU delirium is based on the use of typical (haloperidol) and atypical (i.e. quetiapine) antipsychotics. Non-pharmacological methods include early mobilization, ensuring day and night cycles, the minimalization of noctural factors (light, sounds, interventions), and family engagement. Conclusion: Sepsis-associated encephalopathy is a serious illness associated with severe consequences, including increased mortality, long-term cognitive dysfunction, and immunosuppression. The co-dependence between septic encephalopathy and the immune system should be underlined in the approach towards sepsis treatment. Keywords: sepsis associated encephalopathy; sepsis; ICU delirium; CAM-ICU; cognitive dysfunction. ABSTRAKT Wstęp:Encefalopatia septyczna (sepsis-associated encephalopathy -SAE) jest ostrym zaburzeniem funkcjonowania ośrodko-wego układu nerwowego (OUN), które pojawia się w następstwie infekcji ogólnoustrojowej, jednak bez infekcji samego mózgu. Celem ninie...

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Sepsis-associated encephalopathy

Cited by 581 publications

References 77 publications

Initial Presenting as Acute Vertigo Syndrome in Sepsis Associated Encephalopathy: A Retrospective Case Series

Initial Presenting as Acute Vertigo Syndrome in Sepsis Associated Encephalopathy: A Retrospective Case Series

Endotoxin-induced lung alveolar cell injury causes brain cell damage

Encefalopatia septyczna a majaczenie stanu ciężkiego

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