The Encephalopathy of Sepsis

Abstract

ABSTRACT:Twelve fatal cases of encephalopathy associated with sepsis were examined in a ten-year retrospective study. The sources of infection and organisms isolated were variable. Six of the patients had focal neurologic signs; five had seizures. The level of consciousness varied from drowsiness to deep coma, and electroencephalograms revealed diffuse or multifocal abnormalities. Computed tomographic head scans and cerebrospinal fluid examinations were usually unremarkable. Eight patients had disseminated microabscesses in the brain at autopsy. Four patients had proliferation of astrocytes and microglia in the cerebral cortex, a feature associated with metabolic encephalopathies. Additional findings included cerebral infarcts, brain purpura, multiple small white matter hemorrhages, and central pontine myelinolysis. Although sepsis may cause encephalopathy by producing disturbances in cerebral synaptic transmission and cerebral energy production through a toxic mechanism, bacterial invasion of the brain with the formation of disseminated microabscesses is also an important cause.

Neurological Sequelae of Sepsis: I) Septic Encephalopathy

“…2). Jackson et al retrospectively showed cerebral hemorrhage, ischemic infarcts and central pontine myelinolysis each in 2 of 12 patients (~17%), whereas disseminated micro-abscesses were detectable in 8 of 12 patients (~67%) [46]. Similar lesions were described in another study with neuropathological examination of 4 patients, however, their incidence varied greatly and none showed micro-abscesses [51].…”

“…CT scans are mostly normal [12,46], however, also white matter hypodensities are reported [47]. MR imaging in a case series of patients with septic shock and acute neurological signs revealed various degrees of leukencephalopathy as well as multiple ischemic strokes [48].…”

Sequelae of Traumatic Injuries and Causes of Death

“…The facultative histomorphological features of septic encephalopathy were described as follows: cerebral infarcts (17%), brain purpura and multiple small haemorrhages (17%), septicopyaemic microabscesses (67%) (Fig. 17.21), proliferation of astrocytes and microglia in the cerebral cortex (17%) and central pontine myelinolysis (17%) (Jackson et al 1985). Every forensic pathologist will agree that these findings, apart from septicopyaemic abscesses, are highly unproductive for establishing the postmortem diagnosis of sepsis.…”

Sepsis and Dialysis Disequilibrium Syndrome

“…These abnormalities includes proliferation of astrocytes, cerebral infarcts, multiple white matter hemorrhages, central pontine myelinolysis, multiple microabceses, reduction in cerebral blood flow , cerebral capillary leakage, and malfunctioning of the blood brain barrier. 10 These septic encephalopathy changes can be amplified if patient is having traumatic brain injury, subarachnoid hemorrhage or on hemodialysis.…”