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Posterior Reversible Encephalopathy in Sepsis-Associated Encephalopathy: Experience from a Single Center

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An Invited Commentary to this article was published on 08 February 2022

Abstract

Background

Sepsis-associated encephalopathy (SAE) is frequently encountered in sepsis and is often accompanied by neuroimaging findings indicating ischemia, hemorrhage, and edema. Posterior reversible encephalopathy syndrome (PRES) has been vastly underrecognized in previously reported cohorts of patients with sepsis and SAE. Our aim was to determine the prevalence and distinguishing clinical, neuroimaging, and electroencephalography features of PRES in SAE.

Methods

In this prospective observational study, patients with radiologically identified PRES were selected from a consecutively enrolled cohort of 156 patients with SAE and assessed for neurological outcome using the extended Glasgow Outcome Scale for 12 months. Patients with SAE and PRES and other types of brain lesions were compared in terms of clinical and diagnostic workup features.

Results

Fourteen of 156 patients (8.9%) were determined to be radiologically compatible with PRES, whereas 48 patients displayed other types of acute brain lesions. Patients with PRES often showed lesions in atypical regions, including frontal lobes, the corpus callosum, and the basal ganglia. Source of infection was mostly gram-negative bacteria originating from pneumonia or intraabdominal infections. Patients with PRES were not different from other patients with SAE with brain lesions in terms of features of sepsis and neurological outcome. However, patients with PRES showed increased prevalence of seizures and intraabdominal source of infection.

Conclusions

PRES is highly prevalent in SAE, often encompasses unusual brain regions, and usually presents with generalized seizures. Patients with SAE and PRES do not appear to have distinguishing clinical and diagnostic workup features. However, generalized seizures may serve as warning signs for presence of PRES in patients with SAE.

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Acknowledgements

The authors thank the personnel of the Multidisciplinary Critical Care Unit at the University of Istanbul for support.

Funding

This study was funded by the Scientific Research Projects Coordination Unit of Istanbul University (Grant No. 35165).

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Authors and Affiliations

  1. Department of Anesthesiology and Intensive Care, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey

    Günseli Orhun, Perihan Ergin Özcan & Figen Esen

  2. Department of Neuroradiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey

    Serra Sencer & Mehmet Barburoğlu

  3. Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey

    Erdem Tüzün

  4. Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey

    Nerses Bebek

  5. Department of Biostatistics, İstanbul University, İstanbul, Turkey

    Mehmet Güven Günver

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  1. Günseli Orhun
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Contributions

GO, SS, ET, NB, and FE contributed to conception and design of the study. GO, FE, ET, and PEÖ contributed to acquisition, analysis, and interpretation of data from patients with sepsis. NB contributed to acquisition, analysis, and interpretation of electroencephalographic analysis of patients with sepsis. SS and MB contributed to acquisition, analysis, and interpretation of brain magnetic resonance imaging. MGG performed the statistical analysis. GO, SS, ET, NB, and FE were involved in drafting the manuscript or revising it critically for important intellectual content. All authors read and approved the final manuscript.

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Correspondence to Günseli Orhun.

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All authors declare that they have no conflict of interests.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the institutional review board (approval number: 2013/98), and informed consent was obtained from all individual participants, or their relatives, included in the study.

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Orhun, G., Sencer, S., Tüzün, E. et al. Posterior Reversible Encephalopathy in Sepsis-Associated Encephalopathy: Experience from a Single Center. Neurocrit Care 36, 372–386 (2022). https://doi.org/10.1007/s12028-021-01433-8

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  • DOI: https://doi.org/10.1007/s12028-021-01433-8

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