The diagnosis of brain dysfunction in septic shock patients relies essentially on neurological examination and neurological tests, such as electroencephalography and neuroimaging. Neuroimaging can reveal acute intracerebral structural lesions and their reversibility, helping with management and prognosis. Advances in knowledge: Ischaemic lesions and cerebritis are the most common brain anomalies complicating paediatric septic shock.

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BackgroundBrain injury is frequently observed during septic shock and may be primarily related to the direct effects of the septic insult on the brain or to secondary/indirect injuries (e.g., hypotension, hypoxemia and hyperglycaemia). We sought to assess incidence and pattern of brain lesions diagnosed by neuroimaging in paediatric septic shock patients.MethodsRetrospective descriptive hospital-based study included paediatric patients with a single episode of septic shock admitted to our paediatric intensive care unit (PICU) from January 2010 to December 2013.Results49 of 193 septic shock patients, with a median age 2.6 years (range 7 days-15 years), had a neuroimaging examination [computerised tomography (CT) only 22 (45%), magnetic resonance imaging (MRI) only 14 (29%) and both 13 (27%)]. Neuroimaging was normal in 16 patients (33%) and showed acute lesions in 20 patients (41%). The findings were: cerebral infarcts/hypoxic ischaemic injury in 8 (16%), cerebritis in 7 (14%), mixed lesions (ischaemia and cerebritis) in 1 (2%), posterior reversible encephalopathy syndrome (PRES) in 1 (2%), sinus venous thrombosis in 1 (2%) and haemorrhage in 2 (4%). The incidence of acute brain lesion in our septic shock cohort was 10% (20 of 193). EEG was recorded on 33 (67%) patients with neuroimaging and showed cerebral dysfunction in 28 (85%). EEG abnormalities were not predictive of neuroimaging alterations. Clinical neurological manifestations triggered neuroimaging investigation on 33 (67%) patients, being the most frequent decreased level of consciousness in 17 (35%), followed by seizures in 15 (31%).ConclusionsThe diagnosis of brain dysfunction in septic shock patients relies essentially on neurological examination and neurological tests, such as EEG and neuroimaging. Neuroimaging can reveal acute intra-cerebral structural lesions and their reversibility, helping with management and prognosis. Longer term outcome studies are required to determine the full significance of our findings.

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