Brain lesions in septic shock: a magnetic resonance imaging study
- 832 Downloads
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.
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.
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.
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.
KeywordsSeptic shock Brain Inflammation Blood–brain barrier
- 10.Sharshar T, Gray F, Lorin de la Grandmaison G, Hopkinson NS, Ross E, Dorandeu A, Orlikowski D, Raphael J-C, Gajdos P, Annane D (2003) Apoptosis of neurons in cardiovascular autonomic centres triggered by inducible nitric oxide synthase after death from septic shock. Lancet 362:1799–1805CrossRefPubMedGoogle Scholar
- 11.Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ (1992) Definitions for sepsis and organ failure and guidelines for use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference. American College of Chest Physician/Society of Critical Care Medicine. Chest 101:1644–1655.CrossRefPubMedGoogle Scholar
- 13.Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhardt CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710CrossRefPubMedGoogle Scholar
- 15.Wijdicks EF (2002) Coma and other states of altered awareness. In: Wijdicks EF (ed). Neurologic complications of critical illness. Oxford University Press, pp 3–27Google Scholar
- 16.Schmidt R, Fazekas F, Kleinert G, Offenbacher H, Gindl K, Payer F, Freidl W, Niederkon K, Lechner H (1992) Magnetic resonance imaging signal hyperintensities in the deep and sucortical white matter: a comparative study between stroke patients and normal volunteers. Arch Neurol 49:825–827CrossRefPubMedGoogle Scholar
- 28.Fayed N, Modrego PJ, Morales H (2006) Evidence of brain damage after high-altitude climbing by means of magnetic resonance imaging. Am J Med 19:161–166Google Scholar
- 29.Mueller CA, Schluesener HJ, Conrad S, Meyermann R, Schwab JM (2003) Lesional expression of a proinflammatory and antiangionic cytokine EMAP II confined to endothelium and microglia/macrophages during secondary damage following experimental traumatic brain injury. J Neuroimmunol 135:1–9CrossRefPubMedGoogle Scholar
- 31.Ely EW, Truman B, Shintani A, Thomason JWW, Wheeler AP, Gordon S, Francis J, Speroff T, Gautam S, Margolin R, Sessler CN, Dittus RS, Bernard GR (2003) Monitoring sedation status over time in ICU patients. Reliability and validity of the Richmond Agitation–Sedation Scale (RASS). JAMA 289:2983–2991CrossRefPubMedGoogle Scholar