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

Andrea Polito (1) , Frédéric Eischwald (2) , Anne-Laure Le Maho (1) , Angelo Polito (3) , Eric Azabou (4) , Djillali Annane (1) , Fabrice Chrétien (5) , Robert Stevens (6) , Robert Carlier (2) , Tarek Sharshar (1)

1 General Intensive Care Medicine
2 Department of Radiology
3 Cardiac Intensive Care Unit
4 Epilepsie, sommeil et explorations fonctionnelles neuropédiatriques
5 Histopathologie humaine et Modèles animaux
6 Departments of Anesthesiology and Critical Care Medicine

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.

Domaines: Physiologie [q-bio.TO]

Andrea Polito, Frédéric Eischwald, Anne-Laure Le Maho, Angelo Polito, Eric Azabou, et al.. Pattern of Brain Injury in the Acute Setting of Human Septic Shock. Critical Care, 2013, 17 (5), pp.R204. ⟨10.1186/cc12899⟩. ⟨pasteur-00879187⟩