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Pattern of brain injury in the acute
Critical Care2013, 17:R204
Andrea Polito (andreaF d i Ei h ld (f
Critical Care
mailto:[email protected]:[email protected]:[email protected]:[email protected]7/27/2019 Sepsis Cerebro
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PATTERN OF BRAIN INJURY IN THE ACUT
Andrea Polito1; Frdric Eischwald
2; Anne-Laure L
Annane1; Fabrice Chrtien
5; Robert D Steve
1
General Intensive Care Medicine Assistance Publique H
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Abstract
Background: Sepsis-associated brain dysfunctio
(leucoencephalopathy) and ischemic stroke. Our o
lesions in septic shock patients requiring magn
l i l h
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Introduction
Brain dysfunction is a frequent and severe complic
patients [1, 2] and is associated with increased mort
5]. It is clinically characterized by an acute alter
delirium and less frequently by seizures or focal
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Materials and methods
Patients and settings
This was a prospective observational study that wa
intensive care unit (ICU) of an university teaching
France). Patients were enrolled at our institution fro
li ibl f i l i if th t th f ll i
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tendon reflexes and plantar reflexes. Coma was def
three days of discontinuation of sedation in previou
as generalized or focal (face or limb) tonic or clon
or eyelid twitching. Any lateralized deficit was cons
B i M ti R I i
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In patients with ischemic stroke, a standard ECG, a
performed. In patients with arrhythmias, continuo
Health Care, Ultraview SL, Washington, USA
classification, patients were eventually classified
atherosclerosis (thrombo-embolic) episode [16]. A
d li i i d t EEG i ti E
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were represented by ICU mortality, hospital and
ventilation and GOS at 6 months (dichotomized at
Statistical Analysis
STATA software, Version 111 data analysis and st
T ) d f t ti ti l l i C ti
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Results
From November 2005 to June 2012, 170 patients
acute brain dysfunction; of those, 71 (42%) patients
median time delay from acute brain dysfunction of
enrolled because of patients death before MRI (n
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severity of septic shock and hemodynamic failur
subgroups (Table 2) as well as pathogens, v
prothrombin time, haemoglobin and lactate levels
were more frequently associated with ischemic
underwent an EEG, four had mixed brain lesions an
f t i ti t ith i l t d i h i t k
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Discussion
Our observational study shows that, in septic sh
brain MRI can reveal leukoencephalopathy or isch
ICU mortality and increased odds of having GOS>
ischemic stroke (31%) is higher than previously rep
[8] Thi di b l i d b th f t
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More sophisticated analysis including plasma cyt
warranted for future studies.
Finally, we found that MRI is normal in 52% of o
with those obtained by Suchyta et al in critically
l i i ti ti t i ht b b d th l
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strength, use of spectroscopy and of diffusion te
smaller ischemic lesions or other anatomical or neu
A larger cohort of patients would allow a more accu
brain lesion and their respective risk factors. Yet av
scant, often retrospective, single centre and have in
diffi lti t f h l ti i ti
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2. Ischemic stroke is associated with increasedbiological DIC.
3. Severity and type of neuroradiological lesion
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Abbreviations
ADC: Apparent Diffusion Coefficient; ATICE: ABBB: blood-brain barrier; CAM-ICU: Confusi
disseminated intravascular coagulation; DW
electrocardiogram; EEG: electroencephalography
attenuated inversion recovery; GCS: Glasgow Com
I i C U i MBP bl d
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References
1. Iacobone E, Bailly-Salin J, Polito A, Fr
associated encephalopathy and its differe
336.
2. Sprung CL, Peduzzi PN, Shatney CH, Sche
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Marshall J, Ranieri M, Ramsay G, Sevran
Zimmerman JL, Vincent JL: Surviving Se
management of severe sepsis and septic sh
10. Siami S, Bailly-Salin J, Polito A, Porcher R
V, Boucly C, Carlier R, Annane D, Sharshar
l d i h h f i h
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16. Adams HP, Jr., Bendixen BH, Kappelle LJ,
Classification of subtype of acute ischem
clinical trial. TOAST. Trial of Org 10172
41.
17. Synek VM: Prognostically important E
i h l hi i d l C
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25. Walkey AJ, Wiener RS, Ghobrial JM, C
mortality associated with new-onset atr
severe sepsis.JAMA 2011, 306:2248-2254.
26. Lee JY, Insel P, Mackin RS, Schuff N, Ch
MW: Different associations of white matte
l
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LEGEND OF FIGURES
Figure 1 Flow chart. Other neurological di
cerebrovascular disease, brain infection and end
presence of metallic devices.
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Table 1 - Main characteristics between admission, i
VARIABLES ADMISSION
Women
Age (years)
Cardiovascular risk factors (%)
Atrial fibrillation (%)
Blood culture (%)
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Abbreviations
SAPS-II: New Simplified Acute Physiology ScorSepsis-related Organ Failure Assessment; PaO2: pa
oxygen saturation; MBP: mean blood pressure; DI
intensive care unit; GOS: Glasgow Outcome Scale
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Table 2 Comparison of demographic characteris
with normal MRI, isolated ischemic stroke and leuc
Total
63
Normal
37
Demographics
Age (years) 64 (55-75) 61 (48-78)
Women 25 (40) 12 (32)
Cardiovascular risk 37 (59) 19 (51)
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Table 3 Comparison of neurological and electroen
normal MRI, isolated leukoencephalopathy or isola
Clinical features Total
63
Normal
37
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Figure 2
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Figure 3
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Figure 4