Brain lesions in septic shock: a?magnetic resonance imaging study
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- 作者：Tarek Sharshar (1)
Robert Carlier (2)
Francis Bernard (3)
Céline Guidoux (1)
Jean-Philippe Brouland (4)
Olivier Nardi (1)
Geoffroy Lorin de la Grandmaison (5)
Jér?me Aboab (1)
Fran?oise Gray (4)
David Menon (3)
Djillali Annane (1) - 关键词：Septic shock ; Brain ; Inflammation ; Blood–brain barrier
- 刊名：Intensive Care Medicine
- 出版年：2007
- 出版时间：May 2007
- 年：2007
- 卷：33
- 期：5
- 页码：798-806
- 全文大小：538KB
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Robert Carlier (2)
Francis Bernard (3)
Céline Guidoux (1)
Jean-Philippe Brouland (4)
Olivier Nardi (1)
Geoffroy Lorin de la Grandmaison (5)
Jér?me Aboab (1)
Fran?oise Gray (4)
David Menon (3)
Djillali Annane (1)
1. Service de Réanimation Médicale, H?pital Raymond Poincaré (APHP), Faculté de Médecine Paris Ile de France Ouest (UVSQ), 104, Boulevard Raymond Poincaré, 92380, Garches, France
2. Service de Radiologie, H?pital Raymond Poincaré (APHP), Faculté de Médecine Paris Ile de France Ouest (UVSQ), 104, Boulevard Raymond Poincaré, 92380, Garches, France
3. University of Cambridge, Box 93, Addenbrooke’s Hospital, CB2 2QQ, Cambridge, UK
4. Service d’Anatomo-Pathologie, H?pital Lariboisière, 1, rue Ambroise Paré, 75010, Paris, France
5. Service d’Anatomo-Pathologie et de Médecine Légale, Université de Versailles SQY, H?pital Raymond Poincaré (AP-HP), 104, Boulevard Raymond Poincaré, 92380, Garches, France
文摘
Background Understanding of sepsis-induced brain dysfunction remains poor, and relies mainly on data from animals or post-mortem studies in patients. The current study provided findings from magnetic resonance imaging of the brain in septic shock. Methods Nine patients with septic shock and brain dysfunction [7?women, median age 63?years (interquartile range 61-9?years), SAPS II: 48 (44-6), SOFA: 8 (6-0)] underwent brain magnetic resonance imaging including gradient echo T1-weighted, fluid-attenuated inversion recovery (FLAIR), T2-weighted and diffusion isotropic images, and mapping of apparent diffusion coefficient. Results Brain imaging was normal in two patients, showed multiple ischaemic strokes in two patients, and in the remaining patients showed white matter lesions at the level of the centrum semiovale, predominating around Virchow–Robin spaces, ranging from small multiple areas to diffuse lesions, and characterised by hyperintensity on FLAIR images. The main lesions were also characterised by reduced signal on diffusion isotropic images and increased apparent diffusion coefficient. The lesions of the white matter worsened with increasing duration of shock and were correlated with Glasgow Outcome Score. Conclusion This preliminary study showed that sepsis-induced brain lesions can be documented by magnetic resonance imaging. These lesions predominated in the white matter, suggesting increasedblood–brain barrier permeability, and were associated with poor outcome.