2018 issue 1

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Volume 34, issue 1

Review article

Septic encephalopathy – diagnostics and treatment

Joanna Rybacka-Mossakowska1, Natalia Jawień2, Piotr Smuszkiewicz2, Krzysztof Kusza2, Sławomir Michalak1
1. Zakład Neurochemii i Neuropatologii, Katedra Neurologii, Uniwersytet Medyczny im. K. Marcinkowskiego w Poznaniu
2. Klinika Anestezjologii, Intensywnej Terapii i Leczenia Bólu, Uniwersytet Medyczny im. K. Marcinkowskiego w Poznaniu
Farmakoterapia w Psychiatrii i Neurologii 2018, 34 (1), 33–48
Date of publication: 16-05-2018
DOI: http://dx.medra.org/10.17393/fpn.2018.04.004
Keywords: sepsis, qualitative consciousness disturbances, delirium, septic encephalopathy

Abstract

Sepsis-associated encephalopathy (SAE) is a centralnervous system disorder which develops in the course of an infection. About 1/3 of patients with an infection manifest qualitative consciousness disturbances possiblyrelated to SAE. This phenomenon is underdiagnosed inboth the general and specialised practices and in particular in the emergency medicine settings.This review paper is aimed at specifying the pathomechanisms, diagnostic procedures and differentialdiagnostics of SAE. The SAE diagnosis is possible in patients with qualitative or quantitative consciousness disturbances or a cognitive and executive functioning impairment who fulfil the sepsis diagnostic criteria. In differential diagnosis and monitoring of SAE patients the clinimetric methods are used: Richmond Agitation and Sedation Scale (RASS), Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and Sequential Organ Failure Assessment score (SOFA), along with neurophysiology (electroencephalography), neuroimaging (magnetic resonance imaging) and laboratory tests (C-reactive protein, procalcitonin, biomarkers of central nervous system and blood-brain barrier damage). The treatment of SAE patients is based on the infection control and homeostasis maintenance. During symptomatic treatment, benzodiazepines should be avoided, and dexmedetomidine seems to be beneficial. Potentially, the treatment with intravenous immunoglobulins may be favourable.

Address for correspondence:
Joanna Rybacka-Mossakowska
Zakład Neurochemii i Neuropatologii,
Katedra Neurologii, Uniwersytet Medyczny
im. K. Marcinkowskiego w Poznaniu
ul. Przybyszewskiego 49, 60-355 Poznań
phone: +48 61 8691 443, fax: 61 8691 444
email: joannarybacka@gmail.com