Das Hirn als frühes Sepsisorgan

Septische Enzephalopathie

Die septische Enzephalopathie stellt eine pathophysiologisch komplexe Hirnfunktionsstörung septischer Patienten dar. Ihr Schweregrad korreliert mit der Mortalität. Häufig ist die Enzephalopathie das Erstsymptom einer Infektionserkrankung. Aufgrund dieser Tatsache und der bis heute fehlenden spezifischen Therapieoptionen ist eine frühe Erkennung mit der Chance einer umgehenden antimikrobiellen Behandlung sowie die differenzialdiagnostische Abgrenzung gegenüber anderen Ursachen eines Enzephalopathie-Syndromes entscheidend.

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Literatur

  1. 1.

    Karl Eibl: Johann Wolfgang Goethe. Samtliche Werke, Briefe, Tagebucher und Gesprache, Bd. 2. Deutscher Klassiker-Verlag: 1987, S. 107-108

  2. 2.

    https://www.de.wikipedia.org/wiki/Erlkonig_(Ballade)

  3. 3.

    Vincent JL, Sakr Y, Sprung CL et al Sepsis Occurrence in Acutely Ill Patients Investigators. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med. 2006;34(2):344–53

    Article  PubMed  Google Scholar 

  4. 4.

    Singer M, Deutschman CS, Seymour CW et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801–10

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Chaudhry N, Duggal AK. Sepsis Associated Enzephalopathy. Adv Med. 2014;2014:762320. doi: 10.1155/2014/762320

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Eidelman LA, Putterman D, Putterman C, Sprung CL. The spectrum of septic enzephalopathy. Definitions, etiologies, and mortalities. JAMA. 1996;275(6):470–3

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Sonneville R, Verdonk F, Rauturier C et al. Understanding brain dysfunction in sepsis. Ann Intensive Care. 2013;3(1):15

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Papadopoulos MC, Lamb FJ, Moss RF et al. Faecal peritonitis causes oedema and neuronal injury in pig cerebral cortex. Clin Sci (Lond). 1999;96(5):461–6

    CAS  Article  Google Scholar 

  9. 9.

    Londono D, Cadavid D. Bacterial lipoproteins can disseminate from the periphery to inflame the brain. Am J Pathol. 2010;176(6):2848–57

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Stellwagen D, Malenka RC. Synaptic scaling mediated by glial TNF-alpha. Nature. 2006;440(7087):1054–9

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Semmler A, Okulla T, Sastre M et al. Systemic inflammation induces apoptosis with variable vulnerability of different brain regions. J Chem Neuroanat. 2005;30(2-3):144–57

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Tsuruta R, Oda Y. A clinical perspective of sepsis-associated delirium. J Intensive Care. 2016;4:18

    Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Barr J, Fraser GL, Puntillo K et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41(1):263–306

    Article  PubMed  Google Scholar 

  14. 14.

    Hosokawa K, Gaspard N, Su F et al. Clinical neurophysiological assessment of sepsis-associated brain dysfunction: a systematic review. Crit Care. 2014;18(6):674

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Young GB, Bolton CF, Archibald YM et al. The electroenzephalogram in sepsis-associated enzephalopathy. J Clin Neurophysiol. 1992;9(1):145–52

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Azabou E, Magalhaes E, Braconnier A et al. Early Standard Electroenzephalogram Abnormalities Predict Mortality in Septic Intensive Care Unit Patients. PLoS One. 2015;10(10):e0139969

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Pierrakos C, Antoine A, Velissaris D et al. Transcranial doppler assessment of cerebral perfusion in critically ill septic patients: a pilot study. Ann Intensive Care. 2013;3:28

  18. 18.

    Yao B, Zhang LN, Ai YH et al. Serum S100β is a better biomarker than neuron-specific enolase for sepsis-associated enzephalopathy and determining its prognosis: a prospective and observational study. Neurochem Res. 2014;39(7):1263–9

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Ziaja M. Septic enzephalopathy. Curr Neurol Neurosci Rep. 2013;13(10):383

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Stubbs DJ, Yamamoto AK, Menon DK. Imaging in sepsis-associated enzephalopathy—insights and opportunities. Nat Rev Neurol. 2013;9(10):551–61

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Dellinger RP, Levy MM, Rhodes A et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41(2):580–637

    Article  PubMed  Google Scholar 

  22. 22.

    Sui DM, Xie Q, Yi WJ et al. Resveratrol Protects against Sepsis-Associated Enzephalopathy and Inhibits the NLRP3/IL-1β Axis in Microglia. Mediators Inflamm. 2016;2016:1045657. doi: 10.1155/2016/1045657

    Article  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Flierl MA, Stahel PF, Rittirsch D et al. Inhibition of complement C5a prevents breakdown of the blood-brain barrier and pituitary dysfunction in experimental sepsis. Crit Care. 2009;13(1):R12

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Toklu HZ, Uysal MK, Kabasakal L et al. The effects of riluzole on neurological, brain biochemical, and histological changes in early and late term of sepsis in rats. J Surg Res. 2009;152(2):238–48

    CAS  Article  PubMed  Google Scholar 

  25. 25.

    Ranieri VM, Thompson BT, Barie PS et al. Drotrecogin alfa (activated) in adults with septic shock. N Engl J Med. 2012;366(22):2055–64

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Burkhart CS, Dell-Kuster S, Siegemund M et al. Effect of n-3 fatty acids on markers of brain injury and incidence of sepsis-associated delirium in septic patients. Acta Anaesthesiol Scand. 2014;58(6):689–700

    CAS  Article  PubMed  Google Scholar 

  27. 27.

    Page VJ, Davis D, Zhao XB et al. Statin use and risk of delirium in the critically ill. Am J Respir Crit Care Med. 2014;189(6):666–73

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Morandi A, Hughes CG, Thompson JL et al. Statins and delirium during critical illness: a multicenter, prospective cohort study. Crit Care Med. 2014;42(8):1899–909

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  29. 29.

    Page VJ, Ely EW, Gates S et al. Effect of intravenous haloperidol on the duration of delirium and coma in critically ill patients (Hope-ICU): a randomised, double-blind, placebo-controlled trial. Lancet Respir Med. 2013;1(7):515–23. Erratum in: Lancet Infect Dis. 2014;14(11):1040

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Pandharipande PP, Sanders RD, Girard TD et al. Effect of dexmedetomidine versus lorazepam on outcome in patients with sepsis: an a priori-designed analysis of the MENDS randomized controlled trial. Crit Care. 2010;14(2):R38

    Article  PubMed  PubMed Central  Google Scholar 

  31. 31.

    Iwashyna TJ, Ely EW, Smith DM, Langa KM. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA. 2010;304(16):1787–94

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Semmler A, Widmann CN, Okulla T et al. Persistent cognitive impairment, hippocampal atrophy and EEG changes in sepsis survivors. J Neurol Neurosurg Psychiatry. 2013;84(1):62–9

    Article  PubMed  Google Scholar 

  33. 33.

    Götz T, Günther A, Witte OW et al. Long-term sequelae of severe sepsis: cognitive impairment and structural brain alterations - an MRI study (LossCog MRI). BMC Neurol. 2014;14:145

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Oberfeldarzt Dr. med. Sven Lerch.

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Lerch, S. Septische Enzephalopathie. CV 16, 41–45 (2016). https://doi.org/10.1007/s15027-016-0999-3

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