Septic encephalopathy occurs easily in many septic persons. Manifestations are largely similar to those seen in other metabolic brain diseases. It can be detected most sensitivily, but not specifically, with electroencephalography. Diagnosis is based on excluding other causes of encephalopathy, such as a central nervous system infection or exposure to drugs or toxins. The pathogenesis is unknown but is likely diverse. Its severity correlates with mortality. Early recognition of septic encephalopathy is essential becuase early: diagnosis and treatment of sepsis markedly reduces mortality.
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References
1.
SprungCLPeduzziPNShatneyCH, et al. Impact of encephalopathy on mortality in the sepsis syndrome. The Veterans Administration Systemic Sepsis Cooperative Study Group. Crit Care Med1990;18:801-806
2.
YoungGBBoltonCF.Septic encephalopathy: what significance in patients with sepsis? J Crit Ill1992;7:668-682
3.
ShatneyCHLilleheiRC.Septic shock in patients with surgical disease of the colon and rectum. Dis Colon Rectum1978;21:480-486
4.
SprungCLCaralisPVMarcialEH, et al. The effects of high-dose corticosteroids in patients with septic shock. A prospective, controlled study. N Engl J Med1984;311:1137-1143
5.
BoneRCFisherCJJrClemmerTP, et al. A controlled clinical trial of high-dose methylprednisolone in the treatment of severe sepsis and septic-shock. N Engl J Med1987;317:653-658.
6.
BartonRCerraFB.The hypermetabolism multiple organ failure syndrome. Chest1989;96:1153-1160
7.
YoungGBBoltonCFAustinTW, et al. The encephalopathy associated with septic illness. Clin Invest Med1990;13:297-304
8.
BaueAE.Multiple, progressive or sequential systems failure—a syndrome of the 1970s. Arch Surg1975;110:110-779
9.
BoneRCSprungCLSibbaldWJ.Definition of sepsis and organ failure. Crit Care Med1992;20:724-726
10.
FryDEPearlsteinLFultonRL, et al. Multiple system organ failure: the role of uncontrolled infection. Arch Surg1980;118:242-249
11.
PineRWWertzMJLennardES, et al. Determinants of organ malfunction or death in patients with intra-abdominal sepsis: a discriminant analysis. Arch Surg1983;118:242-249
12.
MarshallJCChristouNVHornR, et al. The microbiology of multiple organ failure: the proximal gastrointestinal tract as an occult reservoir of pathogens. Arch Surg1988;123:309-315
13.
FryDEPearlsteinLFultonRL, et al. Multiple system organ failure: the role of uncontrolled infection. Arch Surg1980;115:136-140
14.
BoneCRFisherCJJrClemerTR, et al. Sepsis syndrome: a valid clinical entity. Crit Care Med1989;17:389-393
15.
AustinTW.Septicemia. In: SibbaldWJ, ed. Synopsis of critical care. Baltimore: Williams & Wilkins, 1988:229-233
16.
PlumFPosnerJB.The diagnosis of stupor and coma. ed 3. Philadelphia: FA Davis, 1982:177-303
17.
BengtssonFBuggeMHanssonL, et al. Serotonin metabolism in the central nervous system following sepsis or portacaval shunt in the rat. J Surg Res1987;43:420-429
18.
PendleburyWWPerlDPMunozDG.Multiple microabscesses in the central nervous system: a clinicopathologic study. J Neuropathol Exp Neurol1989;48:290-300
19.
JacksonACGilbertJJYoungGB, et al. The encephalopathy of sepsis. Can J Neurol Sci1985;12:303-307
20.
MesulamMMGeschwindN.Disordered mental states in the postoperative period. Urol Clin North Am1976;3:199-215
21.
SprungCLCerraFBFreundHR, et al. Amino acid alterations and encephalopathy in sepsis syndrome. Crit Care Med1991;19:753-757.
22.
FolsteinMFFolsteinSEMcHughPR. “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res1975;12:189-198
23.
LapresisJRisvegliatoM.L'encephalite metastatique infectiuse. La Nouvelle Presse Medicale1980;9:437-438
24.
SimonRP.Forced downward ocular deviation. Occurrence during oculovestibular testing in sedative drug-induced coma. Arch Neurol1987;35:456-458
25.
BoltonCFYoungGB.Neurological complications of renal failure. Toronto: Butterworths, 1990
26.
YoungGBBoltonCFArchibaldYM, et al. The electroencephalogram in sepsis-associated encephalopathy. J Clin Neurophysiol1992;9:145-152
27.
BoltonCFGilbertJJHahnAF, et al. Polyneuropathy in critically ill patients. J Neurol Neurosurg Psychiatry1984;47:1223-1231
28.
BoltonCFLavertyDABrownJD, et al. Critically ill polyneuropathy: electrophysiological studies and differentiation from Guillain-Barré syndrome. J Neurol Neurosurg Psychiatry1986;49:563-573
29.
BoltonCF.Electrophysiologic studies of critically ill patients. Muscle Nene1987;10:129-135
CallahanM.Fulminant bacterial meningitis without meningeal signs. Ann Emerg Med1989;18:90-93
32.
PendleburyWWPerlDPKaribpRM, et al. Disseminated microabscesses of the central nervous system (abstract). Neurology1983;33(suppl 2):223
33.
GrahamDI.Vascular disease and hypoxic brain damage. In: WellerRO, ed. Nervous system, muscle and eyes, vol 4. (Symmers WStC, general ed. Systemic Pathology). New York: Churchill Livingstone, 1990:107.
34.
AnkerPStrounM.Bacterial ribonucleic acid in the frog brain after a bacterial peritoneal infection. Science1972;178:621-623
35.
BowronDLBertelsNHProughDS, et al. Cerebral blood flow is reduced in patients with sepsis syndrome. Crit Care Med1989;17:399-403
36.
ParkerJLEmersonTEJr.Cerebral hemodynamics, vascular reactivity, and metabolism during canine endotoxic shock. Circ Shock1977;4:41-53
37.
FischerJEFunovicsJMAguirreA, et al. The role of plasma amino acids in hepatic encephalopathy. Surgery1975; 78:276
38.
WijdicksEFMStevensM.The role of hypotension in septic encephalopathy following surgical procedures. Arch Neurol1992;49:653–656
39.
Du MoulinGCPatersonDHedley-WhyteJ, et al. E. coli peritonitis and bacteremia cause increased blood-brain barrier permeability. Brain Res1985340:261-268
40.
GlauserMPZanettiGBaumgartnerJ-D, et al. Septic shock: pathogenesis. Lancet1991;338:732–736
41.
TuchschmidtJOblitasDFriedJC.Oxygen consumption in sepsis and septic shock. Crit Care Med1991;19:664–671
42.
CerraFBCheungNKFischerJE, et al. Disease specific amino acid infusion (F080) in hepatic encephalopathy: a prospective, randomised, double-blind, controlled trial. JPEN1985;9:288–295
43.
ConnHO.Branched chain amino acids in hepatic encephalopathy. Hepatology1986;6:148–150
44.
TakezawaJTaenakaNNishijimaMK, et al. Amino acids and thiobarbituric acid reactive substances in cerebrospinal fluid and plasma of patients with septic encephalopathy. Crit Care Med1983;11:876–879
45.
MizockBASabelliHCDubinA, et al. Septic encephalopathy. Evidence for altered phenylalanine metabolism and comparison with hepatic encephalopathy. Arch Intern Med1990;150:443–449
46.
FreundHRRyanJAFischerJE.Amino acid derangements in patients with sepsis: treatment with branched chain amino acid rich infusions. Ann Surg1978;188:423–430
47.
VenteJPVon MeyenfeldtMFVan EijkHM, et al. Plasma-amino acid profiles in sepsis and stress. Ann Surg1989;209:57–62
48.
MelaL.Direct and indirect effects of endotoxin on mitochondrial function. Prog Clin Biol Res1981;62:15–21
49.
EkstromJBHaggendalELarssonLE.Cerebral blood flow and oxygen uptake in endotoxic shock. An experimental study in dogs. An experimental study in dogs. Acta Anaesthesiol Scand1982;26:163–170
50.
HeardSOFinkMP.Multiple organ failure syndrome—part 1: Epidemiology, prognosis, and pathophysiology. Intensive Care Med1991;6:279–294
51.
NistioGDe SarroG.Is interleukin 2 a neuromodulator in the brain? TINS1991;14:146–150
52.
LeJVilcekJ.Tumor necrosis factor and interleukin 1: cytokines with multiple overlapping biological activities. Lab Invest1987;56:234–248
53.
PohlmanTHStannessKABeattyPG, et al. An endothelial cell surface factor(s) induced in vitro by lipopolysaccharide, interleukin 1, and tumor necrosis factor-alpha increases neutrophil adherence by a CDw 18-dependent mechanism. J Immunol1986;136:4548–4553
54.
QuagliarelloVJWispelweyBLongWJ, et al. Recombinant human interleukin-1 induces meningitis and blood-brain barrier injury in the rat. J Clin Invest1991;87:1360–1366
55.
CarlsenEFlatmarkAPrydzH.Cytokine-induced procoagulant activity in monocytes and endothelial cells. Transplantation1988;46:575–580
