%0 Journal Article
%T Sepsis Associated Encephalopathy
%A Neera Chaudhry
%A Ashish Kumar Duggal
%J Advances in Medicine
%D 2014
%R 10.1155/2014/762320
%X Sepsis associated encephalopathy (SAE) is a common but poorly understood neurological complication of sepsis. It is characterized by diffuse brain dysfunction secondary to infection elsewhere in the body without overt CNS infection. The pathophysiology of SAE is complex and multifactorial including a number of intertwined mechanisms such as vascular damage, endothelial activation, breakdown of the blood brain barrier, altered brain signaling, brain inflammation, and apoptosis. Clinical presentation of SAE may range from mild symptoms such as malaise and concentration deficits to deep coma. The evaluation of cognitive dysfunction is made difficult by the absence of any specific investigations or biomarkers and the common use of sedation in critically ill patients. SAE thus remains diagnosis of exclusion which can only be made after ruling out other causes of altered mentation in a febrile, critically ill patient by appropriate investigations. In spite of high mortality rate, management of SAE is limited to treatment of the underlying infection and symptomatic treatment for delirium and seizures. It is important to be aware of this condition because SAE may present in early stages of sepsis, even before the diagnostic criteria for sepsis can be met. This review discusses the diagnostic approach to patients with SAE along with its epidemiology, pathophysiology, clinical presentation, and differential diagnosis. 1. Introduction Sepsis is one of the most common reasons for presentation to the emergency department accounting for 6.4% of admissions [1, 2]. Sepsis and its attendant complications cause more deaths than prostate cancer, breast cancer, and HIV/AIDS combined together imposing a major financial burden on the health care system. Sepsis associated encephalopathy (SAE) is a multifactorial syndrome, characterized as diffuse cerebral dysfunction induced by the systemic response to the infection without clinical or laboratory evidence of direct brain infection or other types of encephalopathy (e.g., hepatic or renal encephalopathy). The term SAE is preferable to the loosely used term ¡°septic encephalopathy¡± which to some implies a consistent, direct infection of the central nervous system. Instead the term ¡°septic encephalopathy¡± might be used to define a septic state, that is, a systemic inflammatory state summoned by an infectious process of the brain or CNS. Brain dysfunction due to sepsis has been a neglected cause of delirium or altered mental status in critically ill patients primarily because there are no precise, well-established clinical or
%U http://www.hindawi.com/journals/amed/2014/762320/