A szepszishez társuló encephalopathia a szisztémás gyulladásos reakció korai szakaszában jelentkező, gyakori, de klinikai szempontból elhanyagolt tünete. A szisztémás szepszis okozta diffúz agyi működészavar, újabb elnevezés szerint a szepszishez társuló encephalopathia (sepsis-associated encephalopathy – SAE) változatos megjelenésű lehet: az átmeneti, reverzíbilis encephalopathiával jellemezhető formától egészen a visszafordíthatatlan agyi károsodással járó súlyos formáig terjedhet a klinikai spektrum. A jelen közleményben a hazai és a nemzetközi szakirodalom áttekintése alapján össze kívántuk foglalni a kórkép kórélettani hátterét, a leggyakrabban előforduló klinikai tüneteket és a kezelés lehetséges módjait. Fel kívántuk hívni a figyelmet arra, hogy szepszisben a különböző súlyosságú tudatzavar az egyik legkorábbi figyelmeztető tünet, ezért a szepszis szempontjából veszélyeztetett betegekben felismerése nagy klinikai jelentőségű.
Tran, D. D., Groeneveld, A. B., van der Meulen, J. és mtsai: Age, chronic disease, sepsis, organ system failure, and mortality in a medical intensive care unit. Crit. Care Med., 1990, 18 , 474–479.
Meulen J. , 'Age, chronic disease, sepsis, organ system failure, and mortality in a medical intensive care unit ' (1990 ) 18 Crit. Care Med. : 474 -479 .
Pine, R. W., Wertz, M. J., Lennard, E. S.: Determinants of organ malfunction or death in patients with intra-abdominal sepsis. Arch. Surg., 1983, 118 , 242–249.
Lennard E. S. , 'Determinants of organ malfunction or death in patients with intra-abdominal sepsis ' (1983 ) 118 Arch. Surg. : 242 -249 .
Parillo, J. E., Parker, M. M., Natanson, C. és mtsai: Septic shock in humans. Advances in the understanding of pathogenesis, cardiovascular dysfunction and therapy. Ann. Intern. Med., 1990, 113 , 227–242.
Natanson C. , 'Septic shock in humans. Advances in the understanding of pathogenesis, cardiovascular dysfunction and therapy ' (1990 ) 113 Ann. Intern. Med. : 227 -242 .
Jeppsson, B., Freund, H. R., Gimmon, Z. és mtsai: Blood-brain barrier derangement in sepsis: cause of septic encephalopathy? Am. J. Surg., 1981, 141 , 136–142.
Gimmon Z. , 'Blood-brain barrier derangement in sepsis: cause of septic encephalopathy? ' (1981 ) 141 Am. J. Surg. : 136 -142 .
Sprung, C. L., Peduzzi, P. N., Shatney, C. H. és mtsai: Impact of encephalopathy on mortality in the sepsis syndrome. The Veterans Administration Systemic Sepsis Cooperative Study Group. Crit. Care Med., 1990, 18 , 801–806.
Shatney C. H. , 'Impact of encephalopathy on mortality in the sepsis syndrome. The Veterans Administration Systemic Sepsis Cooperative Study Group ' (1990 ) 18 Crit. Care Med. : 801 -806 .
Bleck, T. P., Smith, M. C., Pierre-Louise, S. J. és mtsai: Neurological complications of critical medical illnesses. Crit. Care Med., 1993, 21 , 98–103.
Pierre-Louise S. J. , 'Neurological complications of critical medical illnesses ' (1993 ) 21 Crit. Care Med. : 98 -103 .
Nguyen, D. N., Spapen, H., Su, F. és mtsai: Elevated serum levels of S-100beta protein and neuron-specific enolase are associated with brain injury in patients with severe sepsis and septic shock. Crit. Care Med., 2006, 34 , 1967–1974.
Su F. , 'Elevated serum levels of S-100beta protein and neuron-specific enolase are associated with brain injury in patients with severe sepsis and septic shock ' (2006 ) 34 Crit. Care Med. : 1967 -1974 .
Ebersoldt, M., Sharshar, T., Annane, D.: Sepsis-associated delirium. Intensive Care Med., 2007, 33 , 941–950.
Annane D. , 'Sepsis-associated delirium ' (2007 ) 33 Intensive Care Med. : 941 -950 .
Wilson, J. X., Young, B.: Sepsis-associated encephalopathy: evolving concepts. Can. J. Neurol. Sci., 2003, 30 , 98–105.
Young B. , 'Sepsis-associated encephalopathy: evolving concepts ' (2003 ) 30 Can. J. Neurol. Sci. : 98 -105 .
Young, G. B., Bolton, C. F., Archibald, Y. M. és mtsai: The electroencephalogram in SAE. J. Clin. Neurophysiol., 1992, 9 , 145–152.
Archibald Y. M. , 'The electroencephalogram in SAE ' (1992 ) 9 J. Clin. Neurophysiol. : 145 -152 .
Eidelman, L. A., Putterman, D., Putterman, C. és mtsa: The spectrum of septic encephalopathy. Definitions, etiologies, and mortalities. JAMA, 1996, 14 , 470–473.
Putterman C. , 'The spectrum of septic encephalopathy. Definitions, etiologies, and mortalities ' (1996 ) 14 JAMA : 470 -473 .
Zauner, C., Gendo, A., Kramer, L. és mtsai: Metabolic encephalopathy in critically ill patients suffering from septic or nonseptic multiple organ failure. Crit. Care Med., 2000, 28 , 1310–1315.
Kramer L. , 'Metabolic encephalopathy in critically ill patients suffering from septic or nonseptic multiple organ failure ' (2000 ) 28 Crit. Care Med. : 1310 -1315 .
Zauner, C., Gendo, A., Kramer, L. és mtsai: Impaired subcortical and cortical sensory evoked potential pathway in septic patients. Crit. Care Med., 2002, 30 , 1136–1139.
Kramer L. , 'Impaired subcortical and cortical sensory evoked potential pathway in septic patients ' (2002 ) 30 Crit. Care Med. : 1136 -1139 .
Orlikowski, D., Sharshar, T., Annane, D.: The brain in sepsis. Advances in sepsis, 2003, 3 , 8–14.
Annane D. , 'The brain in sepsis ' (2003 ) 3 Advances in sepsis : 8 -14 .
Bolton, C. F., Young, G. B., Zochodone, D. W.: The neurological complications of sepsis. Ann. Neurol., 1993, 33 , 94–100.
Zochodone D. W. , 'The neurological complications of sepsis ' (1993 ) 33 Ann. Neurol. : 94 -100 .
Young, G. B., Bolton, C. F., Austin, T. W. és mtsai: The encephalopathy associated with septic illness. Clin. Invest. Med., 1990, 13 , 297–304.
Austin T. W. , 'The encephalopathy associated with septic illness ' (1990 ) 13 Clin. Invest. Med. : 297 -304 .
Jackson, A. C., Gilbert, J. J., Young, G. B. és mtsa: The encephalopathy of sepsis. Can. J. Neurol. Sci., 1985, 12 , 303–307.
Young G. B. , 'The encephalopathy of sepsis ' (1985 ) 12 Can. J. Neurol. Sci. : 303 -307 .
Clawson, C. C., Hartmann, J. F., Vernier, R. L.: Electron microscopy of the effect of Gram-negative endotoxin on the blood-brain barrier. J. Comp. Neurol., 1966, 127 , 183–198.
Vernier R. L. , 'Electron microscopy of the effect of Gram-negative endotoxin on the blood-brain barrier ' (1966 ) 127 J. Comp. Neurol. : 183 -198 .
Papadopoulos, M. C., Davies, D. C., Moss, R. F. és mtsai: Pathophysiology of septic encephalopathy: a review. Crit. Care Med., 2000, 28 , 3019–3024.
Moss R. F. , 'Pathophysiology of septic encephalopathy: a review ' (2000 ) 28 Crit. Care Med. : 3019 -3024 .
Davies, D. C.: Blood-brain barrier breakdown in septic encephalopathy and brain tumors. J. Anat., 2002, 200 , 639–646.
Davies D. C. , 'Blood-brain barrier breakdown in septic encephalopathy and brain tumors ' (2002 ) 200 J. Anat. : 639 -646 .
Norenberg, M. D.: Astrocyte responses to CNS injury. J. Neuropathol. Exp. Neurol., 1994, 53 , 213–220.
Norenberg M. D. , 'Astrocyte responses to CNS injury ' (1994 ) 53 J. Neuropathol. Exp. Neurol. : 213 -220 .
Du Moulin, G. C., Paterson, D., Hedley-White, J. és mtsa: E. coli peritonitis and bacteremia cause increased blood-brain barrier permeability. Brain Res., 1995, 340 , 261–268.
Hedley-White J. , 'E. coli peritonitis and bacteremia cause increased blood-brain barrier permeability ' (1995 ) 340 Brain Res. : 261 -268 .
Willard, L. B., Hauss-Wegrzyniak, B., Danysz, W. és mtsa: The cytotoxicity of chronic neuroinflammation upon basal forebrain cholinergic neurons of rats can be attenuated by glutamatergic antagonism or cyclooxygenase-2 inhibition. Exp. Brain Res., 2000, 134 , 58–65.
Danysz W. , 'The cytotoxicity of chronic neuroinflammation upon basal forebrain cholinergic neurons of rats can be attenuated by glutamatergic antagonism or cyclooxygenase-2 inhibition ' (2000 ) 134 Exp. Brain Res. : 58 -65 .
Wilson, J. X.: Antioxidant defense of the brain: a role for astrocytes. Can. J. Physiol. Pharmacol., 1997, 75 , 1149–1163.
Wilson J. X. , 'Antioxidant defense of the brain: a role for astrocytes ' (1997 ) 75 Can. J. Physiol. Pharmacol. : 1149 -1163 .
Szatmári Sz., Végh T., Kovács E. és mtsai: Az agyi arteriolák funkciója szepszishez asszociált enkefalopátiában károsodott. Aneszteziológia és Intenzív Terápia, 2009, 39 , 220–226.
Kovács E. , 'Az agyi arteriolák funkciója szepszishez asszociált enkefalopátiában károsodott ' (2009 ) 39 Aneszteziológia és Intenzív Terápia : 220 -226 .
Szatmári, Sz., Végh, T., Csomós, Á. és mtsai: Impaired cerebrovascular reactivity in sepsis-associated encephalopathy studied by acetazolamide test. Crit. Care, 2010, 14 , R50.
Csomós Á. , 'Impaired cerebrovascular reactivity in sepsis-associated encephalopathy studied by acetazolamide test ' (2010 ) 14 Crit. Care : R50 -.
Vincent, J. L.: Microvascular endothelial dysfunction: a renewed appreciation of sepsis pathophysiology. Crit. Care, 2001, 5 , S1–S5.
Vincent J. L. , 'Microvascular endothelial dysfunction: a renewed appreciation of sepsis pathophysiology ' (2001 ) 5 Crit. Care : S1 -S5 .
Grinnell, B. W., Joyce, D.: Recombinant human activated protein C: a system modulator of vascular function for treatment of severe sepsis. Crit. Care Med., 2001, 29 , S53–S60.
Joyce D. , 'Recombinant human activated protein C: a system modulator of vascular function for treatment of severe sepsis ' (2001 ) 29 Crit. Care Med. : S53 -S60 .
Sprung, C. L., Cerra, F. B., Freund, H. R. és mtsai: Amino acid alterations and encephalopathy in the sepsis syndrome. Crit. Care Med., 1991, 19 , 753–757.
Freund H. R. , 'Amino acid alterations and encephalopathy in the sepsis syndrome ' (1991 ) 19 Crit. Care Med. : 753 -757 .
Basler, T., Meier-Hellmann, A., Bredle, D. és mtsa: Amino acid imbalance early in septic encephalopathy. Intensive Care Med., 2002, 28 , 293–298.
Bredle D. , 'Amino acid imbalance early in septic encephalopathy ' (2002 ) 28 Intensive Care Med. : 293 -298 .
Freund, H. R., Ryan, J. A., Fischer, J. E.: Amino acid derangements in patients with sepsis: treatment with branched chain amino acid rich infusions. Ann. Surg., 1978, 188 , 423–430.
Fischer J. E. , 'Amino acid derangements in patients with sepsis: treatment with branched chain amino acid rich infusions ' (1978 ) 188 Ann. Surg. : 423 -430 .
Freund, H. R., Muggia-Sullam, M., Peiser, J. és mtsai: Brain neurotransmitter profile is deranged during sepsis and septic encephalopathy in the rat. J. Surg. Res., 1985, 38 , 267–271.
Peiser J. , 'Brain neurotransmitter profile is deranged during sepsis and septic encephalopathy in the rat ' (1985 ) 38 J. Surg. Res. : 267 -271 .
Winder, T. R., Minuk, G. Y., Sargeant, E. J. és mtsa: Gamma-aminobutyric acid (GABA) and sepsis-related encephalopathy. Can. J. Neurol. Sci., 1988, 15 , 23–25.
Sargeant E. J. , 'Gamma-aminobutyric acid (GABA) and sepsis-related encephalopathy ' (1988 ) 15 Can. J. Neurol. Sci. : 23 -25 .