Department of Anesthesiology and Intensive Care, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Department of Neuroradiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Neurocrit Care. 2022 Apr;36(2):372-386. doi: 10.1007/s12028-021-01433-8. Epub 2022 Feb 8.
Sepsis-associated encephalopathy (SAE) is frequently encountered in sepsis and is often accompanied by neuroimaging findings indicating ischemia, hemorrhage, and edema. Posterior reversible encephalopathy syndrome (PRES) has been vastly underrecognized in previously reported cohorts of patients with sepsis and SAE. Our aim was to determine the prevalence and distinguishing clinical, neuroimaging, and electroencephalography features of PRES in SAE.
In this prospective observational study, patients with radiologically identified PRES were selected from a consecutively enrolled cohort of 156 patients with SAE and assessed for neurological outcome using the extended Glasgow Outcome Scale for 12 months. Patients with SAE and PRES and other types of brain lesions were compared in terms of clinical and diagnostic workup features.
Fourteen of 156 patients (8.9%) were determined to be radiologically compatible with PRES, whereas 48 patients displayed other types of acute brain lesions. Patients with PRES often showed lesions in atypical regions, including frontal lobes, the corpus callosum, and the basal ganglia. Source of infection was mostly gram-negative bacteria originating from pneumonia or intraabdominal infections. Patients with PRES were not different from other patients with SAE with brain lesions in terms of features of sepsis and neurological outcome. However, patients with PRES showed increased prevalence of seizures and intraabdominal source of infection.
PRES is highly prevalent in SAE, often encompasses unusual brain regions, and usually presents with generalized seizures. Patients with SAE and PRES do not appear to have distinguishing clinical and diagnostic workup features. However, generalized seizures may serve as warning signs for presence of PRES in patients with SAE.
脓毒症相关性脑病（SAE）在脓毒症中很常见，常伴有影像学表现为缺血、出血和水肿。在以前报道的脓毒症和 SAE 患者队列中，后部可逆性脑病综合征（PRES）被大大低估了。我们的目的是确定 PRES 在 SAE 中的患病率以及其独特的临床、神经影像学和脑电图特征。
在这项前瞻性观察性研究中，从连续纳入的 156 例 SAE 患者中选择影像学确诊为 PRES 的患者，并使用扩展格拉斯哥预后评分在 12 个月时评估其神经预后。比较 SAE 和 PRES 患者与其他类型脑病变患者的临床和诊断检查特征。
在 156 例患者中，有 14 例（8.9%）被确定为影像学上符合 PRES，而 48 例患者显示出其他类型的急性脑病变。PRES 患者的病变常位于非典型区域，包括额叶、胼胝体和基底节。感染源主要是来自肺炎或腹腔内感染的革兰氏阴性菌。与其他有脑病变的 SAE 患者相比，PRES 患者的感染和神经预后无明显差异。然而，PRES 患者癫痫发作和腹腔内感染的发生率更高。
PRES 在 SAE 中发病率很高，常累及不常见的脑区，通常表现为全身性癫痫发作。PRES 合并 SAE 患者的临床和诊断检查特征似乎没有明显区别。然而，全身性癫痫发作可能是 PRES 存在的预警信号。
