title: Pattern of brain injury in the acute setting of human septic shock.
abstract: BACKGROUND
  Sepsis-associated brain dysfunction has been linked to white matter lesions (leukoencephalopathy) and ischemic stroke. Our objective was to assess the prevalence of brain lesions in septic shock patients requiring magnetic resonance imaging (MRI) for an acute neurologic change.
  
  
  METHODS
  Seventy-one septic shock patients were included in a prospective observational study. Patients underwent daily neurological examination. Brain MRI was obtained in patients who developed focal neurological deficit, seizure, coma, or delirium. Electroencephalogy was performed in case of coma, delirium, or seizure. Leukoencephalopathy was graded and considered present when white matter lesions were either confluent or diffuse. Patient outcome was evaluated at 6 months with the Glasgow Outcome Scale (GOS).
  
  
  RESULTS
  We included 71 patients with median age of 65 years (56 to 76) and SAPS II at admission of 49 (38 to 60). MRI was indicated on focal neurological sign in 13 (18%), seizure in 7 (10%), coma in 33 (46%), and delirium in 35 (49%). MRI was normal in 37 patients (52%) and showed cerebral infarcts in 21 (29%), leukoencephalopathy in 15 (21%), and mixed lesions in 6 (8%). EEG malignant pattern was more frequent in patients with ischemic stroke or leukoencephalopathy. Ischemic stroke was independently associated with disseminated intravascular coagulation (DIC), focal neurologic signs, increased mortality, and worse GOS at 6 months.
  
  
  CONCLUSIONS
  Brain MRI in septic shock patients who developed acute brain dysfunction can reveal leukoencephalopathy and ischemic stroke, which is associated with DIC and increased mortality.
authors.forename: Andrea
authors.initials: A
authors.lastname: Polito
authors.forename: Frédéric
authors.initials: F
authors.lastname: Eischwald
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Maho
authors.forename: Angelo
authors.initials: A
authors.lastname: Polito
authors.forename: Eric
authors.initials: E
authors.lastname: Azabou
authors.forename: Djillali
authors.initials: D
authors.lastname: Annane
authors.forename: Fabrice
authors.initials: F
authors.lastname: Chrétien
authors.forename: Robert D
authors.initials: RD
authors.lastname: Stevens
authors.forename: Robert
authors.initials: R
authors.lastname: Carlier
authors.forename: Tarek
authors.initials: T
authors.lastname: Sharshar
mesh_terms: D000208:Acute Disease; D000368:Aged; D001930:Brain Injuries / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000639:trends*; D008279:Magnetic Resonance Imaging / Q000639:trends*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012772:Shock, Septic / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy
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