Original

Intensive Care Medicine

, Volume 33, Issue 5, pp 798-806

First online:

Brain lesions in septic shock: a magnetic resonance imaging study

  • Tarek SharsharAffiliated withService de Réanimation Médicale, Hôpital Raymond Poincaré (APHP), Faculté de Médecine Paris Ile de France Ouest (UVSQ)
  • , Robert CarlierAffiliated withService de Radiologie, Hôpital Raymond Poincaré (APHP), Faculté de Médecine Paris Ile de France Ouest (UVSQ)
  • , Francis BernardAffiliated withUniversity of Cambridge, Box 93, Addenbrooke’s Hospital
  • , Céline GuidouxAffiliated withService de Réanimation Médicale, Hôpital Raymond Poincaré (APHP), Faculté de Médecine Paris Ile de France Ouest (UVSQ)
  • , Jean-Philippe BroulandAffiliated withService d’Anatomo-Pathologie, Hôpital Lariboisière
  • , Olivier NardiAffiliated withService de Réanimation Médicale, Hôpital Raymond Poincaré (APHP), Faculté de Médecine Paris Ile de France Ouest (UVSQ)
  • , Geoffroy Lorin de la GrandmaisonAffiliated withService d’Anatomo-Pathologie et de Médecine Légale, Université de Versailles SQY, Hôpital Raymond Poincaré (AP-HP)
  • , Jérôme AboabAffiliated withService de Réanimation Médicale, Hôpital Raymond Poincaré (APHP), Faculté de Médecine Paris Ile de France Ouest (UVSQ)
  • , Françoise GrayAffiliated withService d’Anatomo-Pathologie, Hôpital Lariboisière
    • , David MenonAffiliated withUniversity of Cambridge, Box 93, Addenbrooke’s Hospital
    • , Djillali AnnaneAffiliated withService de Réanimation Médicale, Hôpital Raymond Poincaré (APHP), Faculté de Médecine Paris Ile de France Ouest (UVSQ) Email author 

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Abstract

Background

Understanding of sepsis-induced brain dysfunction remains poor, and relies mainly on data from animals or post-mortem studies in patients. The current study provided findings from magnetic resonance imaging of the brain in septic shock.

Methods

Nine patients with septic shock and brain dysfunction [7 women, median age 63 years (interquartile range 61–79 years), SAPS II: 48 (44–56), SOFA: 8 (6–10)] underwent brain magnetic resonance imaging including gradient echo T1-weighted, fluid-attenuated inversion recovery (FLAIR), T2-weighted and diffusion isotropic images, and mapping of apparent diffusion coefficient.

Results

Brain imaging was normal in two patients, showed multiple ischaemic strokes in two patients, and in the remaining patients showed white matter lesions at the level of the centrum semiovale, predominating around Virchow–Robin spaces, ranging from small multiple areas to diffuse lesions, and characterised by hyperintensity on FLAIR images. The main lesions were also characterised by reduced signal on diffusion isotropic images and increased apparent diffusion coefficient. The lesions of the white matter worsened with increasing duration of shock and were correlated with Glasgow Outcome Score.

Conclusion

This preliminary study showed that sepsis-induced brain lesions can be documented by magnetic resonance imaging. These lesions predominated in the white matter, suggesting increasedblood–brain barrier permeability, and were associated with poor outcome.

Keywords

Septic shock Brain Inflammation Blood–brain barrier