Septic-Associated Encephalopathy: a Comprehensive Review

Abstract

Septic-associated encephalopathy (SAE) is a key manifestation of sepsis, ranging from delirium to coma and occurring in up to 70% of patients admitted to the ICU. SAE is associated with higher ICU and hospital mortality, and also with poorer long-term outcomes, including cognitive and functional outcomes. The pathophysiology of SAE is complex, and it may involve neurotransmitter dysfunction, inflammatory and ischemic lesions to the brain, microglial activation, and blood-brain barrier dysfunction. Delirium (which is included in the SAE spectrum) is mostly diagnosed with validated scales in the ICU population. There is no established treatment for SAE; benzodiazepines should generally be avoided in this setting. Nonpharmacological prevention and management is key for treating SAE; it includes avoiding oversedation (mainly with benzodiazepines), early mobilization, and sleep promotion.

Neurological manifestations associated with SARS-CoV-2 and other coronaviruses: A narrative review for clinicians

“…Another hypothesis is that CNS damage reflects a more generalized systemic response. Indeed, the release of pro-inflammatory cytokines is thought to play a central role in severe COVID-19 [41] and is one of the key pathogenic pathways described in septic-associated encephalopathy (SAE) [42] . SAE characteristics are similar in some regards to the encephalopathy described in COVID-19 patients: age, illness severity, acute vascular lesion with some posterior reversible encephalopathy syndromes (PRES) [43] , of which several cases have been reported in COVID-19 patients [3] , [44] .…”

Orbitofrontal involvement in a neuroCOVID‐19 patient

“…Third, another possibility is sepsis‐associated encephalopathy, due to blood‐brain barrier (BBB) dysfunction related to systemic infection 17 . Viral infection of olfactory epithelium, could lead to release of regional cytokines, which, in turn, could cause involvement of the contiguous orbitofrontal cortex, through local BBB leakage, with migration of leukocytes and activation of microglial cells.…”

Fecal Microbiota Transplantation: A New Therapeutic Attempt from the Gut to the Brain

“…Sepsis-associated encephalopathy is a key neurological manifestation of sepsis, with symptoms ranging from delirium to coma. It occurs in almost 70% of the ICU patients and is associated with higher ICU and hospital mortality, as well as poor long-term outcomes (including cognitive and functional outcomes) [ 181 , 182 ]. The toxins and other harmful antigens secreted by pathogenic bacteria or viruses can be neutralized by the antibodies produced by antigen-primed B cells.…”