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Sepsis-associated Encephalopathy

Septic Encephalopathy


Presentation

  • Elevated levels of the brain-specific S100B protein are present in many septic patients and reflect the severity of SAE.[ncbi.nlm.nih.gov]
  • This Review discusses the epidemiology and clinical presentation of SAE. Recent evidence for SAE pathophysiology is outlined and a diagnostic approach to patients with this syndrome is presented. Lastly, prognosis and management of SAE is discussed.[ncbi.nlm.nih.gov]
  • RESULTS: Twenty-one patients (55%) were found to present confusion. The majority of the patients presented a PI   1.1 (76%).[ncbi.nlm.nih.gov]
  • This review describes the most recent findings in the pathophysiology, diagnosis, and management of sepsis-associated encephalopathy and focuses on its many presentations.[ncbi.nlm.nih.gov]
  • However, at present, the cellular and molecular mechanisms of SAE have remained elusive. The pathogenesis of SAE is complex and multifactorial, in which activated inflammation is recognized as a major factor.[ncbi.nlm.nih.gov]
Stupor
  • "The first manifestation of SAE is an acute change in mental status, ranging from inattention, disorientation, agitation, somnolence, stupor and coma," the authors write. There is no specific treatment for SAE.[news-medical.net]
  • Arousable by loud voice commands, but immediately lapses into stupor without further response. MAP failed to improve with further increase in norepinephrine. CPP 50 despite increase of ventilatory rate in an effort to decrease ICP.[rense.com]
  • SAE can also lead to stupor and coma. This is the most common encephalopathy in the ICU.[alvinandassociateslnc.com]
  • The overall incidence rate ratio (IRR) for seizures among sepsis survivors was about 5, but was higher for those who also had neurologic dysfunction (such as encephalopathy, delirium, coma, or stupor) during their index hospitalization than in those without[mdedge.com]
Confusion
  • Patients underwent a daily cognitive assessment with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) test. RESULTS: Twenty-one patients (55%) were found to present confusion.[ncbi.nlm.nih.gov]
  • .  Defined as brain dysfunction due to sepsis and SIRS  Also called sepsis-associated delirium  Clinically, acute impairment in the level of consciousness and confusion (manifested by alteration in attention, disorientation and concentration up to[slideshare.net]
  • It can range from slight confusion to coma and can be, although rarely, accompanied by focal neurological signs.[scitechnol.com]
  • This condition can cause mild confusion to deep coma . Wernicke encephalopathy Also known as Wernicke’s disease, this condition is a result of vitamin B-1 deficiency.[healthline.com]
  • […] consciousness that consists of three types: Type B: HE associated with portal-systemic bypass without intrinsic hepatocellular damage Type C: HE associated with end-stage liver disease (ESLD) or cirrhosis with portal-systemic shunt HE can range from minimal confusion[clinicaladvisor.com]
Somnolence
  • "The first manifestation of SAE is an acute change in mental status, ranging from inattention, disorientation, agitation, somnolence, stupor and coma," the authors write. There is no specific treatment for SAE.[news-medical.net]
  • […] euphoria or anxiety, shortened attention span, impaired performance of addition or subtraction Grade II Lethargy or apathy, minimal disorientation for time or place, subtle personality change, inappropriate behavior, asterixis usually present Grade III Somnolence[clinicaladvisor.com]
Altered Mental Status
  • The main sign of SAE is an altered mental status. Electroencephalography is the more sensitive diagnostic test, and allows the grading of the severity of cerebral dysfunction that is related to outcome.[ncbi.nlm.nih.gov]
  • SAE is characterized by an altered mental status (AMS) that ranges from delirium to coma, and can lead to long-term cognitive impairment.[clinicaltrials.gov]
Altered Mental Status
  • The main sign of SAE is an altered mental status. Electroencephalography is the more sensitive diagnostic test, and allows the grading of the severity of cerebral dysfunction that is related to outcome.[ncbi.nlm.nih.gov]
  • SAE is characterized by an altered mental status (AMS) that ranges from delirium to coma, and can lead to long-term cognitive impairment.[clinicaltrials.gov]

Workup

Triphasic Waves
  • EEGs were classified into five groups: normal, excessive theta, predominant delta, triphasic waves, and suppression or burst suppression, in ascending order of severity.[ncbi.nlm.nih.gov]
  • .  No specific test available 1) Electroencephalography (EEG)  Most sensitive diagnostic tool  Normal, diffuse slowing, excessive theta, predominantly delta, triphasic waves, and suppression or burst suppression  Non-specific 13. 2) Short-latency[slideshare.net]
EEG Suppression
  • Patients with lethal outcome were more likely to be female (p 0.0011), to have focal seizures (p 0.034), lower values of GCS during hospitalization (p CONCLUSION: Presence of focal seizures, EEG suppression at the time of exacerbation in SAE elderly patients[ncbi.nlm.nih.gov]
Brain Edema
  • Both patients showed diffuse brain edema on CT and severe brain dysfunction on electroencephalography within a day of onset.[ncbi.nlm.nih.gov]
  • These therapies include mild hyperventilation which curtails intracerebral blood volume, ventricular drainage of CSF and osmotherapy to reduce brain edema/parenchymal volume.[pulmccm.org]
  • Ammonia is thought to result in both cytotoxic and vasogenic brain edema due to the cerebral energy failure, excessive intracellular accumilation of glutamine and alteration in aquaporin-4 integral membrane proteins.[clinicaladvisor.com]

Treatment

  • METHODS: All patients received standard goal-directed resuscitation treatment. Patients with pre-existing or acute neurological disorders were excluded.[ncbi.nlm.nih.gov]
  • At this moment a specific treatment for SAE does not exist and outcome relies upon prompt and appropriate treatment of sepsis as a whole. [Indexed for MEDLINE] Free full text[ncbi.nlm.nih.gov]
  • Most therapeutic options center around aggressive treatment of the underlying infection.[ncbi.nlm.nih.gov]
  • Brain edema aggravated and lasted for a few months despite a variety of treatments. MR imaging in the chronic phase revealed cracking lesions extending to the cerebral white matter, the cerebellum, and the brainstem.[ncbi.nlm.nih.gov]
  • Delirium is caused by an underlying physiological disturbance, and treatment requires identification of the underlying cause. Making this diagnosis requires careful differential diagnosis. However, often the cause of delirium is hard to recognize.[ingentaconnect.com]

Prognosis

  • SAE is potentially reversible, but it always worsens the prognosis. Pathophysiology of SAE is not still completely understood, and it is probably multifactorial.[ncbi.nlm.nih.gov]
  • Lastly, prognosis and management of SAE is discussed.[ncbi.nlm.nih.gov]
  • BACKGROUND: Encephalopathy is a common complication of sepsis, and its onset can occur at any stage of sepsis and implies worse prognosis.[ncbi.nlm.nih.gov]
  • The aim of this study was to study the clinical significance of serum S100β and NSE in diagnosing sepsis-associated encephalopathy (SAE) and predicting its prognosis. This was a prospective and observational study.[ncbi.nlm.nih.gov]
  • Important features include information on neurologic complications in organ transplant recipients, muscle and nerve injury in critical illness, status epilepticus, cerebral edema, multisystem trauma including cervical spine and traumatic brain injury, and prognosis[books.google.com]

Etiology

  • "The spectrum of septic encephalopathy: definitions, etiologies, and mortalities." Jama 275.6 (1996): 470-473. Flierl, Michael A., et al. "Pathophysiology of septic encephalopathy—an unsolved puzzle."[derangedphysiology.com]
  • Interestingly - in patients - elevated procalcitonin was associated with delirum in both infectious and non-infectious etiologies.[pulmccm.org]
  • Definitions, etiologies, and mortalities. JAMA. 1996;275(6):470–3 CrossRef PubMed Google Scholar 7. Sonneville R, Verdonk F, Rauturier C et al. Understanding brain dysfunction in sepsis.[link.springer.com]
  • Pathophysiology There is not a single clear etiology that accounts for the occurrence of HE.[clinicaladvisor.com]

Epidemiology

  • However, the incidence, epidemiology, and pathogenesis of sepsis-associated encephalopathy remain controversial. The purpose of this study was to investigate the epidemiological features and risk factors for sepsis-associated encephalopathy.[ncbi.nlm.nih.gov]
  • This Review discusses the epidemiology and clinical presentation of SAE. Recent evidence for SAE pathophysiology is outlined and a diagnostic approach to patients with this syndrome is presented. Lastly, prognosis and management of SAE is discussed.[ncbi.nlm.nih.gov]
  • Leng, Iris (committee member) Santos, Cesar (committee member) date 2009-08-07T14:13:06Z (accessioned) 2010-06-18T19:00:03Z (accessioned) 2009-08-07T14:13:06Z (available) 2010-06-18T19:00:03Z (available) 2009-08-07T14:13:06Z (issued) degree Clinical Epidemiology[wakespace.lib.wfu.edu]
  • Página 93 - Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. ‎[books.google.es]
  • […] compartment syndrome due to severe ascites Altered neurotransmission Benzodiazepine use Coinciding alcohol withdrawal Psychoactive drugs Acute hepatocellular damage Alcoholic hepatitis Drugs Acute viral hepatitis Development of hepatocellular carcinoma Epidemiology[clinicaladvisor.com]
Sex distribution
Age distribution

Pathophysiology

  • Although the pathophysiology of SAE is incompletely understood, it is thought to involve endothelial activation, blood-brain barrier leakage, inflammatory cell migration, and neuronal loss with neurotransmitter imbalance.[ncbi.nlm.nih.gov]
  • This review describes the most recent findings in the pathophysiology, diagnosis, and management of sepsis-associated encephalopathy and focuses on its many presentations.[ncbi.nlm.nih.gov]
  • Further research into the pathophysiology, management and prevention of SAE is needed. This Review discusses the epidemiology and clinical presentation of SAE.[ncbi.nlm.nih.gov]
  • The clinical significance of this pathophysiological finding has to be assessed in further studies.[ncbi.nlm.nih.gov]
  • Pathophysiology of SAE is not still completely understood, and it is probably multifactorial.[ncbi.nlm.nih.gov]

Prevention

  • Further research into the pathophysiology, management and prevention of SAE is needed. This Review discusses the epidemiology and clinical presentation of SAE.[ncbi.nlm.nih.gov]
  • In summary, we found that heat shock could attenuate the electro-cortical dysfunction in rats with LPS-induced septic response, suggesting that heat shock response might potentially be used to prevent SAE in sepsis. Copyright 2009 Elsevier B.V.[ncbi.nlm.nih.gov]
  • Current philosophy in sepsis management is drifting towards reactivating surviving “dysfunctional/hibernating” cells, including immune system’s own, rather than preventing the non-reachable acute destructive wave of immune activation.[research.pasteur.fr]
  • Página 220 - American Thoracic Society: Hospital-acquired pneumonia in adults: Diagnosis, assessment of severity, initial antimicrobial therapy, and preventive strategies. Am J Respir Crit Care Med 1995;153:1711. ‎[books.google.es]
  • Is chronic lung disease in low birth weight infants preventable? A survey of eight centers. ‎ Página 84 - Tanner JM, Whitehouse RH, Marubini E, Resele LF. The adolescent growth spurt of boys and girls of the Harpenden growth study. ‎[books.google.es]

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