Elevated levels of the brain-specific S100B protein are present in many septic patients and reflect the severity of SAE. [ncbi.nlm.nih.gov]

• Acutely Ill Patient

  Vincent JL, Sakr Y, Sprung CL et al Sepsis Occurrence in Acutely Ill Patients Investigators. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med. 2006;34(2):344–53 CrossRef PubMed Google Scholar 4. [link.springer.com]

  In Europe, severe sepsis affects 90.4 cases per 100 000 adult residents per year and an overall hospital mortality of 36% described in the last Sepsis Occurrence in Acutely ill Patients (SOAP) study [ 1 ]. [journals.plos.org]

• Asterixis

  sub-clinical encephalopathy may be identified by family members as the patient being “not quite right” even thought abnormalities are not obvious to the bedside clinician may progress to coma other features such as anorexia, malaise, myoclonus and asterixis [lifeinthefastlane.com]

   Most common motor sign is paratonic rigidity or gegenhalten, a resistance to passive movement of limbs that is velocity-dependent  Asterixis, multifocal myoclonus, seizures and tremor are relatively infrequent  Cranial nerve functions are almost [slideshare.net]

  Asterixis can be detected. Stage 2. Lethargy or apathy. Minimal disorientation. Inappropriate behavior. Slurred speech. Obvious asterixis. [clevelandclinicmeded.com]

  Grade I Trivial lack of awareness, 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 [clinicaladvisor.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]

• Cognitive Impairment

  Definitions CCC — Long-term cognitive impairment in critically ill patients Journal articles Ebersoldt M, Sharshar T, Annane D. [lifeinthefastlane.com]

  Moreover, sepsis survivors can suffer from long-term cognitive impairments that impact their quality of life. [clinicaltrials.gov]

  SAE were predominantly diagnosed in older patients and in those who had a history of chronic psychiatric, neurological and cognitive impairment, long-term use of psychoactive drugs, alcohol abuse, chronic liver disease, and immune-depression. [esicm.org]

   9 -71% of patients with sepsis develop SE  Patients With known CNS pathology are at greater risk for SE  Often described as a reversible syndrome  New studies show prolonged cognitive impairment and depressive symptoms in sepsis survivors  63% [slideshare.net]

  There is increasing evidence that SAE may pose substantial risks for long-term cognitive impairments, including alterations in mental processing-speed, executive function, memory, attention, and visual-spatial abilities. [alvinandassociateslnc.com]

• 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]

  SAE can also lead to stupor and coma. This is the most common encephalopathy in the ICU. [alvinandassociateslnc.com]

  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]

  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]

• 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]

  Like altered mental status, and unlike lactate, tachypnea does not require a blood test. [emdocs.net]

  Neurotoxicity developed 6 days after positive cultures with altered mental status and blood pressure 128/80 mm Hg. [ajnr.org]

  Back to Top Differential Diagnosis for Hepatic Encephalopathy Distinguishing HE from other acute and chronic causes of altered mental status may be difficult in patients with cirrhosis. [clevelandclinicmeded.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]

  Somnolent but can be aroused, unable to perform mental tasks, gross disorientation about time and place, marked confusion, amnesia, occasional fits of rage, present but incomprehensible speech. Stage 4. [clevelandclinicmeded.com]

When seizure activity must be ruled out, an EEG may be helpful in the initial workup of a patient with cirrhosis and altered mental status. EEG studies are not required to make a confident diagnosis of HE. [clevelandclinicmeded.com]

• Burst Suppression

  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]

  All recordings were assessed for the presence of burst suppression and a maturition score was assigned. [wakespace.lib.wfu.edu]

   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]

  0.5-1 g/Kg body weight as long as serum osmolarity is less than 320 mosm/L Induction of moderate hypothermia to 32-33 degrees C Maintain serum sodium level of 145 to 155 mEql/L using hypertonic saline Induce, with propofol or pentobarbital titrated to burst [clinicaladvisor.com]

• 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]

• White Matter Lesions

  MRI revealed unilateral subcortical white matter lesions in the right hemisphere. She was diagnosed as having sepsis-associated encephalopathy and was treated with dexamethasone and midazolam. [ncbi.nlm.nih.gov]

  Nonspecific white matter lesions are also described in other studies. [6], [7] Finelli and Uphoff reported cases with bilateral basal ganglia, thalamic, cerebellar, brainstem, and cerebral MR abnormalities in sepsis. [8] Furthermore, MR abnormalities [jdrntruhs.org]

  Etiology of cortical and white matter lesions in cyclosporin-A and FK-506 neurotoxicity. AJNR Am J Neuroradiol 2001 ; 22 : 1901 –14 Schwartz RB, Bravo SM, Klufas RA, et al. [ajnr.org]

METHODS: All patients received standard goal-directed resuscitation treatment. Patients with pre-existing or acute neurological disorders were excluded. [ncbi.nlm.nih.gov]

At 24 h post-treatment, expression of 117 lncRNAs and 57 mRNAs was consistently elevated, while expression of 79 lncRNAs and 21 mRNAs was decreased (change 1.5-fold; p 0.05). [biorxiv.org]

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]

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]

"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]

Etiology of cortical and white matter lesions in cyclosporin-A and FK-506 neurotoxicity. AJNR Am J Neuroradiol 2001 ; 22 : 1901 –14 Schwartz RB, Bravo SM, Klufas RA, et al. [ajnr.org]

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]

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]

Sanford, JP (1985) Epidemiology and overview of the problem. In: Septic Shock pp. 1–11, Root, RK, Sande, MA (Eds) Churchill Livingstone, New York. [cambridge.org]

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]

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]

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]

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]