Pattern of Brain Injury in the Acute Setting of Human Septic Shock

Andrea Polito, Frédéric Eischwald, Anne Laure L Maho, Angelo Polito, Eric Azabou, Djillali Annane, Fabrice Chrétien, Robert D. Stevens, Robert Carlier, Tarek Sharshar

Research output: Contribution to journalArticle

Abstract

Background: Sepsis-associated brain dysfunction has been linked to white matter lesions (leukoencephalopathy) and ischemic stroke. Our objective was to assess the prevalence of brain lesions in septic shock patients requiring magnetic resonance imaging (MRI) for an acute neurologic change. Method: 71 septic shock patients were included in a prospective observational study. Patients underwent daily neurological examination. Brain MRI was obtained in patients who developed focal neurological deficit, seizure, coma, or delirium. Electroencephalogy was performed in case of coma, delirium, or seizure. Leukoencephalopathy was graded and considered present when white matter lesions were either confluent or diffuse. Patient outcome was evaluated at 6 months with the Glasgow Outcome Scale (GOS). Results: We included 71 patients with median age of 65 years (56 to 76) and SAPS II at admission of 49 (38 to 60). MRI was indicated on focal neurological sign in 13 (18%), seizure in 7 (10%), coma in 33 (46%), and delirium in 35 (49%). MRI was normal in 37 patients (52%) and showed cerebral infarcts in 21 (29%), leukoencephalopathy in 15 (21%), and mixed lesions in 6 (8%). EEG malignant pattern was more frequent in patients with ischemic stroke or leukoencephalopathy. Ischemic stroke was independently associated with disseminated intravascular coagulation (DIC), focal neurologic signs, increased mortality, and worse GOS at 6 months. Conclusions: Brain MRI in septic shock patients who developed acute brain dysfunction can reveal leukoencephalopathy and ischemic stroke, which is associated with DIC and increased mortality.

Original languageEnglish
Article numberR204
JournalCritical Care
Volume17
Issue number5
DOIs
Publication statusPublished - Sep 18 2013

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Septic Shock
Brain Injuries
Leukoencephalopathies
Magnetic Resonance Imaging
Delirium
Coma
Stroke
Brain
Glasgow Outcome Scale
Seizures
Disseminated Intravascular Coagulation
Mortality
Neurologic Examination
Neurologic Manifestations
Nervous System
Observational Studies
Electroencephalography
Sepsis
Prospective Studies

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Medicine(all)

Cite this

Polito, A., Eischwald, F., Maho, A. L. L., Polito, A., Azabou, E., Annane, D., ... Sharshar, T. (2013). Pattern of Brain Injury in the Acute Setting of Human Septic Shock. Critical Care, 17(5), [R204]. https://doi.org/10.1186/cc12899

Pattern of Brain Injury in the Acute Setting of Human Septic Shock. / Polito, Andrea; Eischwald, Frédéric; Maho, Anne Laure L; Polito, Angelo; Azabou, Eric; Annane, Djillali; Chrétien, Fabrice; Stevens, Robert D.; Carlier, Robert; Sharshar, Tarek.

In: Critical Care, Vol. 17, No. 5, R204, 18.09.2013.

Research output: Contribution to journalArticle

Polito, A, Eischwald, F, Maho, ALL, Polito, A, Azabou, E, Annane, D, Chrétien, F, Stevens, RD, Carlier, R & Sharshar, T 2013, 'Pattern of Brain Injury in the Acute Setting of Human Septic Shock', Critical Care, vol. 17, no. 5, R204. https://doi.org/10.1186/cc12899
Polito A, Eischwald F, Maho ALL, Polito A, Azabou E, Annane D et al. Pattern of Brain Injury in the Acute Setting of Human Septic Shock. Critical Care. 2013 Sep 18;17(5). R204. https://doi.org/10.1186/cc12899
Polito, Andrea ; Eischwald, Frédéric ; Maho, Anne Laure L ; Polito, Angelo ; Azabou, Eric ; Annane, Djillali ; Chrétien, Fabrice ; Stevens, Robert D. ; Carlier, Robert ; Sharshar, Tarek. / Pattern of Brain Injury in the Acute Setting of Human Septic Shock. In: Critical Care. 2013 ; Vol. 17, No. 5.
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