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2013 | OriginalPaper | Buchkapitel

15. Septische Enzephalopathie

verfasst von : C. Terborg, W. Müllges

Erschienen in: Bewusstseinsstörungen und Enzephalopathien

Verlag: Springer Berlin Heidelberg

Zusammenfassung

Septische Enzephalopathien äußern sich als zentrale Funktionsstörungen bei Sepsis, die sich auf keine andere Ursache wie z.B. Blutungen, Infarkte oder zerebrale Infektionen beziehen lassen. Sie ist die häufigste Form einer Enzephalopathie auf Intensivstationen (Inzidenz bis 71%, oft postoperativ) und wird auch als „Intensivpsychose“ oder „intensive care delirium“ bezeichnet. Bereits ein SIRS (systemisches Inflammations-Response-Syndrom) kann als Auslöser reichen. Prädispositionen können vorbestehende ZNS-Läsionen und das hohe Erkrankungsalter sein. Die Prognose für eine Wiederherstellung kognitiver Funktionen bleibt lange unter der Voraussetzung ausbleibender Komplikationen der Sepsis offen (Infarkte, ARDS, Endo-/Myokarditis, MOV, PNP). Flapping Tremor (Asterixis) und Krampfanfälle sind oft im zerebralen Allgemeinsyndrom dieser Enzephalopathie anzutreffen.
Literatur
Zurück zum Zitat ACCP/SCCM (1992) American college of chest physicians/society of critical care medicine consensus conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20: 864–74 ACCP/SCCM (1992) American college of chest physicians/society of critical care medicine consensus conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20: 864–74
Zurück zum Zitat Alexander JJ, Jacob A, Cunningham P, Hensley L, Quigg RJ (2008) Tnf is a key mediator of septic encephalopathy acting through its receptor, tnf receptor-1. Neurochem Int 52: 447–56PubMedCrossRef Alexander JJ, Jacob A, Cunningham P, Hensley L, Quigg RJ (2008) Tnf is a key mediator of septic encephalopathy acting through its receptor, tnf receptor-1. Neurochem Int 52: 447–56PubMedCrossRef
Zurück zum Zitat Bartynski WS, Boardman JF, Zeigler ZR, Shadduck RK, Lister J (2006) Posterior reversible encephalopathy syndrome in infection, sepsis, and shock. AJNR Am J Neuroradiol 27: 2179–90PubMed Bartynski WS, Boardman JF, Zeigler ZR, Shadduck RK, Lister J (2006) Posterior reversible encephalopathy syndrome in infection, sepsis, and shock. AJNR Am J Neuroradiol 27: 2179–90PubMed
Zurück zum Zitat Bleck TP (2006) Neurological disorders in the intensive care unit. Semin Respir Crit Care Med 27: 201–9PubMedCrossRef Bleck TP (2006) Neurological disorders in the intensive care unit. Semin Respir Crit Care Med 27: 201–9PubMedCrossRef
Zurück zum Zitat Bleck TP, Smith MC, Pierre Louis SJ, Jares JJ, Murray J, Hansen CA (1993) Neurologic complications of critical medical illnesses. Crit Care Med 21: 98–103PubMedCrossRef Bleck TP, Smith MC, Pierre Louis SJ, Jares JJ, Murray J, Hansen CA (1993) Neurologic complications of critical medical illnesses. Crit Care Med 21: 98–103PubMedCrossRef
Zurück zum Zitat Bowton DL, Bertels NH, Prough DS, Stump DA (1989) Cerebral blood flow is reduced in patients with sepsis syndrome. Crit Care Med 17: 399–403PubMedCrossRef Bowton DL, Bertels NH, Prough DS, Stump DA (1989) Cerebral blood flow is reduced in patients with sepsis syndrome. Crit Care Med 17: 399–403PubMedCrossRef
Zurück zum Zitat Bozza FA, Garteiser P, Oliveira MF, Doblas S, Cranford R, Saunders D, Jones I, Towner RA, Castro-Faria-Neto HC (2009) Sepsis-associated encephalopathy: A magnetic resonance imaging and spectroscopy study. J Cereb Blood Flow Metab 30: 440–8PubMedCrossRef Bozza FA, Garteiser P, Oliveira MF, Doblas S, Cranford R, Saunders D, Jones I, Towner RA, Castro-Faria-Neto HC (2009) Sepsis-associated encephalopathy: A magnetic resonance imaging and spectroscopy study. J Cereb Blood Flow Metab 30: 440–8PubMedCrossRef
Zurück zum Zitat Ebersoldt M, Sharshar T, Annane D (2007) Sepsis-associated delirium. Intensive Care Med 33: 941–50PubMedCrossRef Ebersoldt M, Sharshar T, Annane D (2007) Sepsis-associated delirium. Intensive Care Med 33: 941–50PubMedCrossRef
Zurück zum Zitat Eidelman LA, Putterman D, Putterman C, Sprung CL (1996) The spectrum of septic encephalopathy. Definitions, etiologies, and mortalities. JAMA 275: 470–3PubMedCrossRef Eidelman LA, Putterman D, Putterman C, Sprung CL (1996) The spectrum of septic encephalopathy. Definitions, etiologies, and mortalities. JAMA 275: 470–3PubMedCrossRef
Zurück zum Zitat Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, Truman B, Speroff T, Gautam S, Margolin R, Hart RP, Dittus R (2001) Delirium in mechanically ventilated patients: Validity and reliability of the confusion assessment method for the intensive care unit (cam-icu). JAMA 286: 2703–10PubMedCrossRef Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, Truman B, Speroff T, Gautam S, Margolin R, Hart RP, Dittus R (2001) Delirium in mechanically ventilated patients: Validity and reliability of the confusion assessment method for the intensive care unit (cam-icu). JAMA 286: 2703–10PubMedCrossRef
Zurück zum Zitat Guenther U, Popp J, Koecher L, Muders T, Wrigge H, Ely EW, Putensen C (2009) Validity and reliability of the cam-icu flowsheet to diagnose delirium in surgical icu patients. J Crit Care 25: 144–51PubMedCrossRef Guenther U, Popp J, Koecher L, Muders T, Wrigge H, Ely EW, Putensen C (2009) Validity and reliability of the cam-icu flowsheet to diagnose delirium in surgical icu patients. J Crit Care 25: 144–51PubMedCrossRef
Zurück zum Zitat Hofer S, Eisenbach C, Lukic IK, Schneider L, Bode K, Brueckmann M, Mautner S et al. (2008) Pharmacologic cholinesterase inhibition improves survival in experimental sepsis. Crit Care Med 36: 404–8PubMedCrossRef Hofer S, Eisenbach C, Lukic IK, Schneider L, Bode K, Brueckmann M, Mautner S et al. (2008) Pharmacologic cholinesterase inhibition improves survival in experimental sepsis. Crit Care Med 36: 404–8PubMedCrossRef
Zurück zum Zitat Hopkins RO, Jackson JC (2006) Long-term neurocognitive function after critical illness. Chest 130: 869–78PubMedCrossRef Hopkins RO, Jackson JC (2006) Long-term neurocognitive function after critical illness. Chest 130: 869–78PubMedCrossRef
Zurück zum Zitat Hsu AA, Fenton K, Weinstein S, Carpenter J, Dalton H, Bell MJ (2008) Neurological injury markers in children with septic shock. Pediatr Crit Care Med 9: 245–51PubMedCrossRef Hsu AA, Fenton K, Weinstein S, Carpenter J, Dalton H, Bell MJ (2008) Neurological injury markers in children with septic shock. Pediatr Crit Care Med 9: 245–51PubMedCrossRef
Zurück zum Zitat Iacobone E, Bailly-Salin J, Polito A, Friedman D, Stevens RD, Sharshar T (2009) Sepsis-associated encephalopathy and its differential diagnosis. Crit Care Med 37: S331–6 Iacobone E, Bailly-Salin J, Polito A, Friedman D, Stevens RD, Sharshar T (2009) Sepsis-associated encephalopathy and its differential diagnosis. Crit Care Med 37: S331–6
Zurück zum Zitat Iwashyna TJ, Ely EW, Smith DM, Langa KM (2010) Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA 304: 1787–94PubMedCrossRef Iwashyna TJ, Ely EW, Smith DM, Langa KM (2010) Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA 304: 1787–94PubMedCrossRef
Zurück zum Zitat Jackson AC, Gilbert JJ, Young GB, Bolton CF (1985) The encephalopathy of sepsis. Can J Neurol Sci 12: 303–7PubMed Jackson AC, Gilbert JJ, Young GB, Bolton CF (1985) The encephalopathy of sepsis. Can J Neurol Sci 12: 303–7PubMed
Zurück zum Zitat Jackson JC, Ely EW, Morey MC, Anderson VM, Denne LB, Clune J, Siebert CS, Archer KR et al. (2011) Cognitive and physical rehabilitation of intensive care unit survivors: Results of the return randomized controlled pilot investigation. Crit Care Med 40: 1088–97CrossRef Jackson JC, Ely EW, Morey MC, Anderson VM, Denne LB, Clune J, Siebert CS, Archer KR et al. (2011) Cognitive and physical rehabilitation of intensive care unit survivors: Results of the return randomized controlled pilot investigation. Crit Care Med 40: 1088–97CrossRef
Zurück zum Zitat Luzzani A, Polati E, Dorizzi R, Rungatscher A, Pavan R, Merlini A (2003) Comparison of procalcitonin and c-reactive protein as markers of sepsis. Crit Care Med 31: 1737–41PubMedCrossRef Luzzani A, Polati E, Dorizzi R, Rungatscher A, Pavan R, Merlini A (2003) Comparison of procalcitonin and c-reactive protein as markers of sepsis. Crit Care Med 31: 1737–41PubMedCrossRef
Zurück zum Zitat Maekawa T, Fujii Y, Sadamitsu D, Yokota K, Soejima Y, Ishikawa T, Miyauchi Y, Takeshita H (1991) Cerebral circulation and metabolism in patients with septic encephalopathy. Am J Emerg Med 9: 139–43PubMedCrossRef Maekawa T, Fujii Y, Sadamitsu D, Yokota K, Soejima Y, Ishikawa T, Miyauchi Y, Takeshita H (1991) Cerebral circulation and metabolism in patients with septic encephalopathy. Am J Emerg Med 9: 139–43PubMedCrossRef
Zurück zum Zitat Nguyen DN, Spapen H, Su F, Schiettecatte J, Shi L, Hachimi-Idrissi S, Huyghens L (2006) 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 34: 1967–74PubMedCrossRef Nguyen DN, Spapen H, Su F, Schiettecatte J, Shi L, Hachimi-Idrissi S, Huyghens L (2006) 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 34: 1967–74PubMedCrossRef
Zurück zum Zitat Papadopoulos MC, Davies DC, Moss RF, Tighe D, Bennett ED (2000) Pathophysiology of septic encephalopathy: A review. Crit Care Med 28: 3019–24PubMedCrossRef Papadopoulos MC, Davies DC, Moss RF, Tighe D, Bennett ED (2000) Pathophysiology of septic encephalopathy: A review. Crit Care Med 28: 3019–24PubMedCrossRef
Zurück zum Zitat Pendlebury WW, Perl DP, Munoz DG (1989) Multiple microabscesses in the central nervous system: A clinicopathologic study. J Neuropathol Exp Neurol 48: 290–300PubMedCrossRef Pendlebury WW, Perl DP, Munoz DG (1989) Multiple microabscesses in the central nervous system: A clinicopathologic study. J Neuropathol Exp Neurol 48: 290–300PubMedCrossRef
Zurück zum Zitat Pfister D, Siegemund M, Dell-Kuster S, Smielewski P, Ruegg S, Strebel SP, Marsch SC, Pargger H, Steiner LA (2008) Cerebral perfusion in sepsis-associated delirium. Crit Care 12: R63 Pfister D, Siegemund M, Dell-Kuster S, Smielewski P, Ruegg S, Strebel SP, Marsch SC, Pargger H, Steiner LA (2008) Cerebral perfusion in sepsis-associated delirium. Crit Care 12: R63
Zurück zum Zitat Pierrakos C, Vincent JL (2010) Sepsis biomarkers: A review. Crit Care 14: R15 Pierrakos C, Vincent JL (2010) Sepsis biomarkers: A review. Crit Care 14: R15
Zurück zum Zitat Pytel P, Alexander JJ (2009) Pathogenesis of septic encephalopathy. Curr Opin Neurol 22: 283–7PubMedCrossRef Pytel P, Alexander JJ (2009) Pathogenesis of septic encephalopathy. Curr Opin Neurol 22: 283–7PubMedCrossRef
Zurück zum Zitat Reinhart K, Brunkhorst FM (Hrsg) (2010) Prävention, Diagnose, Therapie und Nachsorge der Sepsis, 1. Aufl. Thieme, Stuttgart Reinhart K, Brunkhorst FM (Hrsg) (2010) Prävention, Diagnose, Therapie und Nachsorge der Sepsis, 1. Aufl. Thieme, Stuttgart
Zurück zum Zitat Ringer TM, Axer H, Romeike BFM, Zinke J, Brunkhorst F, Witte OW, Günther A (2011) Neurological sequelae of sepsis: I) septic encephalopathy. The Open Critical Care Medicine Journal: 2–7 Ringer TM, Axer H, Romeike BFM, Zinke J, Brunkhorst F, Witte OW, Günther A (2011) Neurological sequelae of sepsis: I) septic encephalopathy. The Open Critical Care Medicine Journal: 2–7
Zurück zum Zitat Rosengarten B, Hecht M, Auch D, Ghofrani HA, Schermuly RT, Grimminger F, Kaps M (2007) Microcirculatory dysfunction in the brain precedes changes in evoked potentials in endotoxin-induced sepsis syndrome in rats. Cerebrovasc Dis 23: 140–7PubMedCrossRef Rosengarten B, Hecht M, Auch D, Ghofrani HA, Schermuly RT, Grimminger F, Kaps M (2007) Microcirculatory dysfunction in the brain precedes changes in evoked potentials in endotoxin-induced sepsis syndrome in rats. Cerebrovasc Dis 23: 140–7PubMedCrossRef
Zurück zum Zitat Rosengarten B, Krekel D, Kuhnert S, Schulz R (2012) Early neurovascular uncoupling in the brain during community acquired pneumonia. Crit Care 16: R64 Rosengarten B, Krekel D, Kuhnert S, Schulz R (2012) Early neurovascular uncoupling in the brain during community acquired pneumonia. Crit Care 16: R64
Zurück zum Zitat Sharshar T, Annane D, de la Grandmaison GL, Brouland JP, Hopkinson NS, Francoise G (2004) The neuropathology of septic shock. Brain Pathol 14: 21–33PubMedCrossRef Sharshar T, Annane D, de la Grandmaison GL, Brouland JP, Hopkinson NS, Francoise G (2004) The neuropathology of septic shock. Brain Pathol 14: 21–33PubMedCrossRef
Zurück zum Zitat Sharshar T, Carlier R, Bernard F, Guidoux C, Brouland JP, Nardi O, de la Grandmaison GL, Aboab J, Gray F, Menon D, Annane D (2007) Brain lesions in septic shock: A magnetic resonance imaging study. Int Care Med 33: 798–806CrossRef Sharshar T, Carlier R, Bernard F, Guidoux C, Brouland JP, Nardi O, de la Grandmaison GL, Aboab J, Gray F, Menon D, Annane D (2007) Brain lesions in septic shock: A magnetic resonance imaging study. Int Care Med 33: 798–806CrossRef
Zurück zum Zitat Siami S, Annane D, Sharshar T (2008) The encephalopathy in sepsis. Crit Care Clin 24: 67–82, viiiPubMedCrossRef Siami S, Annane D, Sharshar T (2008) The encephalopathy in sepsis. Crit Care Clin 24: 67–82, viiiPubMedCrossRef
Zurück zum Zitat Spapen H, Nguyen DN, Troubleyn J, Huyghens L, Schiettecatte J (2010) Drotrecogin alfa (activated) may attenuate severe sepsis-associated encephalopathy in clinical septic shock. Crit Care 14: R54 Spapen H, Nguyen DN, Troubleyn J, Huyghens L, Schiettecatte J (2010) Drotrecogin alfa (activated) may attenuate severe sepsis-associated encephalopathy in clinical septic shock. Crit Care 14: R54
Zurück zum Zitat Straver JS, Keunen RW, Stam CJ, Tavy DL, de Ruiter GR, Smith SJ, Thijs LG, Schellens RG, Gielen G (1998) Nonlinear analysis of eeg in septic encephalopathy. Neurol Res 20: 100–6PubMed Straver JS, Keunen RW, Stam CJ, Tavy DL, de Ruiter GR, Smith SJ, Thijs LG, Schellens RG, Gielen G (1998) Nonlinear analysis of eeg in septic encephalopathy. Neurol Res 20: 100–6PubMed
Zurück zum Zitat Young GB, Bolton CF (1992) Septic encephalopathy: What significance in patients with sepsis? J Crit Illness 7: 668–82 Young GB, Bolton CF (1992) Septic encephalopathy: What significance in patients with sepsis? J Crit Illness 7: 668–82
Zurück zum Zitat Young GB, Bolton CF, Archibald YM, Austin TW, Wells GA (1992) The electroencephalogram in sepsis-associated encephalopathy. J Clin Neurophysiol 9: 145–52PubMedCrossRef Young GB, Bolton CF, Archibald YM, Austin TW, Wells GA (1992) The electroencephalogram in sepsis-associated encephalopathy. J Clin Neurophysiol 9: 145–52PubMedCrossRef
Zurück zum Zitat Zauner C, Gendo A, Kramer L, Funk GC, Bauer E, Schenk P, Ratheiser K, Madl C (2002) Impaired subcortical and cortical sensory evoked potential pathways in septic patients. Crit Care Med 30: 1136–9PubMedCrossRef Zauner C, Gendo A, Kramer L, Funk GC, Bauer E, Schenk P, Ratheiser K, Madl C (2002) Impaired subcortical and cortical sensory evoked potential pathways in septic patients. Crit Care Med 30: 1136–9PubMedCrossRef
Metadaten
Titel
Septische Enzephalopathie Septische Enzephalopathie
verfasst von
C. Terborg
W. Müllges
Copyright-Jahr
2013
Verlag
Springer Berlin Heidelberg
DOI
https://doi.org/10.1007/978-3-642-36915-5_15

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