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Septische Enzephalopathie

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Book cover Bewusstseinsstörungen und Enzephalopathien

Zusammenfassung

Septische Enzephalopathien äußern sich als zentrale Funktionsstörungen bei Sepsis, die sich auf keine andere Ursache wie z.B. Blutungen, Infarkte oder zerebrale Infektionen beziehen lassen. Sie ist die häufigste Form einer Enzephalopathie auf Intensivstationen (Inzidenz bis 71%, oft postoperativ) und wird auch als „Intensivpsychose“ oder „intensive care delirium“ bezeichnet. Bereits ein SIRS (systemisches Inflammations-Response-Syndrom) kann als Auslöser reichen. Prädispositionen können vorbestehende ZNS-Läsionen und das hohe Erkrankungsalter sein. Die Prognose für eine Wiederherstellung kognitiver Funktionen bleibt lange unter der Voraussetzung ausbleibender Komplikationen der Sepsis offen (Infarkte, ARDS, Endo-/Myokarditis, MOV, PNP). Flapping Tremor (Asterixis) und Krampfanfälle sind oft im zerebralen Allgemeinsyndrom dieser Enzephalopathie anzutreffen.

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Literatur

  • ACCP/SCCM (1992) American college of chest physicians/society of critical care medicine consensus conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20: 864–74

    Google Scholar 

  • Alexander JJ, Jacob A, Cunningham P, Hensley L, Quigg RJ (2008) Tnf is a key mediator of septic encephalopathy acting through its receptor, tnf receptor-1. Neurochem Int 52: 447–56

    Article  PubMed  CAS  Google Scholar 

  • Bartynski WS, Boardman JF, Zeigler ZR, Shadduck RK, Lister J (2006) Posterior reversible encephalopathy syndrome in infection, sepsis, and shock. AJNR Am J Neuroradiol 27: 2179–90

    PubMed  CAS  Google Scholar 

  • Bleck TP (2006) Neurological disorders in the intensive care unit. Semin Respir Crit Care Med 27: 201–9

    Article  PubMed  Google Scholar 

  • Bleck TP, Smith MC, Pierre Louis SJ, Jares JJ, Murray J, Hansen CA (1993) Neurologic complications of critical medical illnesses. Crit Care Med 21: 98–103

    Article  PubMed  CAS  Google Scholar 

  • Bowton DL, Bertels NH, Prough DS, Stump DA (1989) Cerebral blood flow is reduced in patients with sepsis syndrome. Crit Care Med 17: 399–403

    Article  PubMed  CAS  Google Scholar 

  • Bozza FA, Garteiser P, Oliveira MF, Doblas S, Cranford R, Saunders D, Jones I, Towner RA, Castro-Faria-Neto HC (2009) Sepsis-associated encephalopathy: A magnetic resonance imaging and spectroscopy study. J Cereb Blood Flow Metab 30: 440–8

    Article  PubMed  Google Scholar 

  • Ebersoldt M, Sharshar T, Annane D (2007) Sepsis-associated delirium. Intensive Care Med 33: 941–50

    Article  PubMed  Google Scholar 

  • Eidelman LA, Putterman D, Putterman C, Sprung CL (1996) The spectrum of septic encephalopathy. Definitions, etiologies, and mortalities. JAMA 275: 470–3

    Article  PubMed  CAS  Google Scholar 

  • Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, Truman B, Speroff T, Gautam S, Margolin R, Hart RP, Dittus R (2001) Delirium in mechanically ventilated patients: Validity and reliability of the confusion assessment method for the intensive care unit (cam-icu). JAMA 286: 2703–10

    Article  PubMed  CAS  Google Scholar 

  • Gofton TE, Young GB (2012) Sepsis-associated encephalopathy. Nat Rev Neurol 8: 557–66

    Article  PubMed  CAS  Google Scholar 

  • Guenther U, Popp J, Koecher L, Muders T, Wrigge H, Ely EW, Putensen C (2009) Validity and reliability of the cam-icu flowsheet to diagnose delirium in surgical icu patients. J Crit Care 25: 144–51

    Article  PubMed  Google Scholar 

  • Hofer S, Eisenbach C, Lukic IK, Schneider L, Bode K, Brueckmann M, Mautner S et al. (2008) Pharmacologic cholinesterase inhibition improves survival in experimental sepsis. Crit Care Med 36: 404–8

    Article  PubMed  CAS  Google Scholar 

  • Hopkins RO, Jackson JC (2006) Long-term neurocognitive function after critical illness. Chest 130: 869–78

    Article  PubMed  Google Scholar 

  • Hsu AA, Fenton K, Weinstein S, Carpenter J, Dalton H, Bell MJ (2008) Neurological injury markers in children with septic shock. Pediatr Crit Care Med 9: 245–51

    Article  PubMed  Google Scholar 

  • Iacobone E, Bailly-Salin J, Polito A, Friedman D, Stevens RD, Sharshar T (2009) Sepsis-associated encephalopathy and its differential diagnosis. Crit Care Med 37: S331–6

    Google Scholar 

  • Iwashyna TJ, Ely EW, Smith DM, Langa KM (2010) Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA 304: 1787–94

    Article  PubMed  CAS  Google Scholar 

  • Jackson AC, Gilbert JJ, Young GB, Bolton CF (1985) The encephalopathy of sepsis. Can J Neurol Sci 12: 303–7

    PubMed  CAS  Google Scholar 

  • Jackson JC, Ely EW, Morey MC, Anderson VM, Denne LB, Clune J, Siebert CS, Archer KR et al. (2011) Cognitive and physical rehabilitation of intensive care unit survivors: Results of the return randomized controlled pilot investigation. Crit Care Med 40: 1088–97

    Article  Google Scholar 

  • Luzzani A, Polati E, Dorizzi R, Rungatscher A, Pavan R, Merlini A (2003) Comparison of procalcitonin and c-reactive protein as markers of sepsis. Crit Care Med 31: 1737–41

    Article  PubMed  CAS  Google Scholar 

  • Maekawa T, Fujii Y, Sadamitsu D, Yokota K, Soejima Y, Ishikawa T, Miyauchi Y, Takeshita H (1991) Cerebral circulation and metabolism in patients with septic encephalopathy. Am J Emerg Med 9: 139–43

    Article  PubMed  CAS  Google Scholar 

  • Nguyen DN, Spapen H, Su F, Schiettecatte J, Shi L, Hachimi-Idrissi S, Huyghens L (2006) Elevated serum levels of s-100beta protein and neuron-specific enolase are associated with brain injury in patients with severe sepsis and septic shock. Crit Care Med 34: 1967–74

    Article  PubMed  CAS  Google Scholar 

  • Papadopoulos MC, Davies DC, Moss RF, Tighe D, Bennett ED (2000) Pathophysiology of septic encephalopathy: A review. Crit Care Med 28: 3019–24

    Article  PubMed  CAS  Google Scholar 

  • Pendlebury WW, Perl DP, Munoz DG (1989) Multiple microabscesses in the central nervous system: A clinicopathologic study. J Neuropathol Exp Neurol 48: 290–300

    Article  PubMed  CAS  Google Scholar 

  • Pfister D, Siegemund M, Dell-Kuster S, Smielewski P, Ruegg S, Strebel SP, Marsch SC, Pargger H, Steiner LA (2008) Cerebral perfusion in sepsis-associated delirium. Crit Care 12: R63

    Google Scholar 

  • Pierrakos C, Vincent JL (2010) Sepsis biomarkers: A review. Crit Care 14: R15

    Google Scholar 

  • Pytel P, Alexander JJ (2009) Pathogenesis of septic encephalopathy. Curr Opin Neurol 22: 283–7

    Article  PubMed  CAS  Google Scholar 

  • Reinhart K, Brunkhorst FM (Hrsg) (2010) Prävention, Diagnose, Therapie und Nachsorge der Sepsis, 1. Aufl. Thieme, Stuttgart

    Google Scholar 

  • Ringer TM, Axer H, Romeike BFM, Zinke J, Brunkhorst F, Witte OW, Günther A (2011) Neurological sequelae of sepsis: I) septic encephalopathy. The Open Critical Care Medicine Journal: 2–7

    Google Scholar 

  • Rosengarten B, Hecht M, Auch D, Ghofrani HA, Schermuly RT, Grimminger F, Kaps M (2007) Microcirculatory dysfunction in the brain precedes changes in evoked potentials in endotoxin-induced sepsis syndrome in rats. Cerebrovasc Dis 23: 140–7

    Article  PubMed  CAS  Google Scholar 

  • Rosengarten B, Krekel D, Kuhnert S, Schulz R (2012) Early neurovascular uncoupling in the brain during community acquired pneumonia. Crit Care 16: R64

    Google Scholar 

  • Sharshar T, Annane D, de la Grandmaison GL, Brouland JP, Hopkinson NS, Francoise G (2004) The neuropathology of septic shock. Brain Pathol 14: 21–33

    Article  PubMed  Google Scholar 

  • Sharshar T, Carlier R, Bernard F, Guidoux C, Brouland JP, Nardi O, de la Grandmaison GL, Aboab J, Gray F, Menon D, Annane D (2007) Brain lesions in septic shock: A magnetic resonance imaging study. Int Care Med 33: 798–806

    Article  Google Scholar 

  • Siami S, Annane D, Sharshar T (2008) The encephalopathy in sepsis. Crit Care Clin 24: 67–82, viii

    Article  PubMed  Google Scholar 

  • Spapen H, Nguyen DN, Troubleyn J, Huyghens L, Schiettecatte J (2010) Drotrecogin alfa (activated) may attenuate severe sepsis-associated encephalopathy in clinical septic shock. Crit Care 14: R54

    Google Scholar 

  • Straver JS, Keunen RW, Stam CJ, Tavy DL, de Ruiter GR, Smith SJ, Thijs LG, Schellens RG, Gielen G (1998) Nonlinear analysis of eeg in septic encephalopathy. Neurol Res 20: 100–6

    PubMed  CAS  Google Scholar 

  • Young GB, Bolton CF (1992) Septic encephalopathy: What significance in patients with sepsis? J Crit Illness 7: 668–82

    Google Scholar 

  • Young GB, Bolton CF, Archibald YM, Austin TW, Wells GA (1992) The electroencephalogram in sepsis-associated encephalopathy. J Clin Neurophysiol 9: 145–52

    Article  PubMed  CAS  Google Scholar 

  • Zauner C, Gendo A, Kramer L, Funk GC, Bauer E, Schenk P, Ratheiser K, Madl C (2002) Impaired subcortical and cortical sensory evoked potential pathways in septic patients. Crit Care Med 30: 1136–9

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Neurologische Klinik, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland

    C. Terborg

  2. Neurologische Univ.-Klinik, Universitätsklinikum Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Deutschland

    W. Müllges

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  1. C. Terborg
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  2. W. Müllges
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Editors and Affiliations

  1. Klinik für Neurologie und Psychiatrie, Friedrich-Ebert-Krankenhaus Neumünster GmbH, Neumünster, Germany

    Hans-Christian Hansen

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Terborg, C., Müllges, W. (2013). Septische Enzephalopathie . In: Hansen, HC. (eds) Bewusstseinsstörungen und Enzephalopathien. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-36915-5_15

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  • DOI: https://doi.org/10.1007/978-3-642-36915-5_15

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-36914-8

  • Online ISBN: 978-3-642-36915-5

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