Sepsis-Associated Encephalopathy as a Differential Diagnosis With Motor Deficit Plus Altered Mental Status

Pathophysiology of Delirium in the Intensive Care Unit

“…Inflammation and coagulopathy universally present in septic patients and represent a highly plausible mechanism of delirium [68][69][70][71][72][73][74][75][76][77][78][79][80][81][82].…”

“…Work on both the inflammatory and ''flow'' impairments in sepsis as related to the brain in sepsis is needed [69,[73][74][75]77,80].…”

“…Several plausible explanations suggest that sepsis may be a gateway to acute CNS dysfunction and brain damage via degradation of the blood-brain barrier and neuroinflammation [68][69][70][71][72][73][74][75][76][77][78][79][80][81][82]. The prevalence of coexistent delirium during sepsis ranges from 9% to 71% depending on diagnostic definitions [71][72][73]. A septic inflammatory cascade has the potential to decrease essential oxygen and nutrient delivery to cells by impairing capillary blood flow [81][82][83].…”

“…These indications suggest that the relationship between sepsis and delirium will continue to be a productive area of research. Regrettably, to date, few studies have specifically examined the role of sepsis in delirium [69,[73][74][75][76][77]80]. To better understand how sepsis and other acute infections may lead to delirium, it will be necessary to develop accurate biomarkers of deliriogenic processes.…”

Endotoxin-induced gene expression differences in the brain and effects of iNOS inhibition and norepinephrine

“…An unspecific psychosyndrome with alterations of consciousness is the main clinicalblank;symptom. In most of the cases its clinical appearance precedes other symptoms of general inflammation [2][3][4]. Perimicrovascular edema and bleeding, endothelial activation, neuronal apoptosis, glial activation, ion channel differences, synthesis of the inducible nitricoxide synthase (iNOS) and changes in neurotransmitter release or concentrations have been reported [1-3, 5, 6].…”