title: Brain lesions in septic shock: a magnetic resonance imaging study.
abstract: 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.
authors: Service de Réanimation Médicale, Hôpital Raymond Poincaré (APHP), Faculté de Médecine Paris Ile de France Ouest (UVSQ), 104, Boulevard Raymond Poincaré, 92380, Garches, France.
authors: Tarek
authors: T
authors: Sharshar
authors: Service de Radiologie, Hôpital Raymond Poincaré (APHP), Faculté de Médecine Paris Ile de France Ouest (UVSQ), 104, Boulevard Raymond Poincaré, 92380, Garches, France.
authors: Robert
authors: R
authors: Carlier
authors: University of Cambridge, Box 93, Addenbrooke's Hospital, CB2 2QQ, Cambridge, UK.
authors: Francis
authors: F
authors: Bernard
authors: Service de Réanimation Médicale, Hôpital Raymond Poincaré (APHP), Faculté de Médecine Paris Ile de France Ouest (UVSQ), 104, Boulevard Raymond Poincaré, 92380, Garches, France.
authors: Céline
authors: C
authors: Guidoux
authors: Service d'Anatomo-Pathologie, Hôpital Lariboisière, 1, rue Ambroise Paré, 75010, Paris, France.
authors: Jean-Philippe
authors: JP
authors: Brouland
authors: Service de Réanimation Médicale, Hôpital Raymond Poincaré (APHP), Faculté de Médecine Paris Ile de France Ouest (UVSQ), 104, Boulevard Raymond Poincaré, 92380, Garches, France.
authors: Olivier
authors: O
authors: Nardi
authors: Service d'Anatomo-Pathologie et de Médecine Légale, Université de Versailles SQY, Hôpital Raymond Poincaré (AP-HP), 104, Boulevard Raymond Poincaré, 92380, Garches, France.
authors: Geoffroy Lorin
authors: GL
authors: de la Grandmaison
authors: Service de Réanimation Médicale, Hôpital Raymond Poincaré (APHP), Faculté de Médecine Paris Ile de France Ouest (UVSQ), 104, Boulevard Raymond Poincaré, 92380, Garches, France.
authors: Jérôme
authors: J
authors: Aboab
authors: Service d'Anatomo-Pathologie, Hôpital Lariboisière, 1, rue Ambroise Paré, 75010, Paris, France.
authors: Françoise
authors: F
authors: Gray
authors: University of Cambridge, Box 93, Addenbrooke's Hospital, CB2 2QQ, Cambridge, UK.
authors: David
authors: D
authors: Menon
authors: 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.
authors: Djillali
authors: D
authors: Annane
mesh_terms: 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
chemical_list: D001786:Blood Glucose; D012964:Sodium