Brain lesions in septic shock: a magnetic resonance imaging study.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
This preliminary study showed that sepsis-induced brain lesions can be documented by magnetic resonance imaging. These lesions predominated in the white matter, suggesting increased blood-brain barrier permeability, and were associated with poor outcome.
Sharshar
Tarek
T
Service de Réanimation Médicale, Hôpital Raymond Poincaré (APHP), Faculté de Médecine Paris Ile de France Ouest (UVSQ), 104, Boulevard Raymond Poincaré, 92380, Garches, France.
Carlier
Robert
R
Service de Radiologie, Hôpital Raymond Poincaré (APHP), Faculté de Médecine Paris Ile de France Ouest (UVSQ), 104, Boulevard Raymond Poincaré, 92380, Garches, France.
Bernard
Francis
F
University of Cambridge, Box 93, Addenbrooke's Hospital, CB2 2QQ, Cambridge, UK.
Guidoux
Céline
C
Service de Réanimation Médicale, Hôpital Raymond Poincaré (APHP), Faculté de Médecine Paris Ile de France Ouest (UVSQ), 104, Boulevard Raymond Poincaré, 92380, Garches, France.
Brouland
Jean-Philippe
JP
Service d'Anatomo-Pathologie, Hôpital Lariboisière, 1, rue Ambroise Paré, 75010, Paris, France.
Nardi
Olivier
O
Service de Réanimation Médicale, Hôpital Raymond Poincaré (APHP), Faculté de Médecine Paris Ile de France Ouest (UVSQ), 104, Boulevard Raymond Poincaré, 92380, Garches, France.
de la Grandmaison
Geoffroy Lorin
GL
Service d'Anatomo-Pathologie et de Médecine Légale, Université de Versailles SQY, Hôpital Raymond Poincaré (AP-HP), 104, Boulevard Raymond Poincaré, 92380, Garches, France.
Aboab
Jérôme
J
Service de Réanimation Médicale, Hôpital Raymond Poincaré (APHP), Faculté de Médecine Paris Ile de France Ouest (UVSQ), 104, Boulevard Raymond Poincaré, 92380, Garches, France.
Gray
Françoise
F
Service d'Anatomo-Pathologie, Hôpital Lariboisière, 1, rue Ambroise Paré, 75010, Paris, France.
Menon
David
D
University of Cambridge, Box 93, Addenbrooke's Hospital, CB2 2QQ, Cambridge, UK.
Annane
Djillali
D
Service de Réanimation Médicale, Hôpital Raymond Poincaré (APHP), Faculté de Médecine Paris Ile de France Ouest (UVSQ), 104, Boulevard Raymond Poincaré, 92380, Garches, France. djillali.annane@rpc.aphp.fr.
D000368:Aged; D001786:Blood Glucose; D001812:Blood-Brain Barrier; D001927:Brain Diseases / Q000175:diagnosis / Q000209:etiology / Q000473:pathology*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012772:Shock, Septic / Q000150:complications / Q000503:physiopathology*; D012964:Sodium / Q000097:blood
D001786:Blood Glucose; D012964:Sodium