title: Multifocal necrotizing leukoencephalopathy in septic shock.
abstract: OBJECTIVE
  Multifocal necrotizing leukoencephalopathy, characterized by multiple microscopic foci of necrosis involving the white matter of the pons, has been described mainly after chemotherapy or radiotherapy for brain cancer and in HIV infection. The role of circulating cytokines has been suggested but remains to be assessed.
  
  
  METHODS
  Prospective case series.
  
  
  METHODS
  A 26-bed general medical intensive care unit at a university hospital.
  
  
  METHODS
  Septic shock patients. MEASUREMENTS AND PATIENTS: In three patients who died from septic shock, careful postmortem examination of the brain was performed, including studies of neuronal apoptosis and cytokine expression.
  
  
  RESULTS
  In one patient, typical lesions of multifocal necrotizing leukoencephalopathy were seen. As compared with control 1 and control 2 who did not have multifocal necrotizing leukoencephalopathy, marked lesions of the pons, including vacuolization, apoptosis, microglial activation, and expression of tumor necrosis factor-alpha and interleukin-1beta, were observed in the case. Simultaneously, case 1 had markedly increased circulating levels for tumor necrosis factor-alpha, interleukin-1beta, interleukin-6, interleukin-8, interleukin-10, soluble tumor necrosis factor receptor II, and for interleukin-1 receptor antagonist.
  
  
  CONCLUSIONS
  Septic shock is a newly described cause of multifocal necrotizing leukoencephalopathy, probably mediated by an excessive systemic inflammatory response.
authors.affiliation: Service de Réanimation Médiale, Hôpital Raymond Poincaré--Faculté de Médecine Paris--Ouest--Université Paris, Garches, France.
authors.forename: Tarek
authors.initials: T
authors.lastname: Sharshar
authors.forename: Françoise
authors.initials: F
authors.lastname: Gray
authors.forename: Frédéric
authors.initials: F
authors.lastname: Poron
authors.forename: Jean Claude
authors.initials: JC
authors.lastname: Raphael
authors.forename: Philippe
authors.initials: P
authors.lastname: Gajdos
authors.forename: Djillali
authors.initials: D
authors.lastname: Annane
mesh_terms: D000328:Adult; D017209:Apoptosis; D016207:Cytokines / Q000097:blood; D005260:Female; D006801:Humans; D007968:Leukoencephalopathy, Progressive Multifocal / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011149:Pons / Q000473:pathology; D012772:Shock, Septic / Q000097:blood / Q000150:complications*
chemical_list: D016207:Cytokines