Brain Volume Changes in Patients with Acute Brain Dysfunction Due to Sepsis.
Amygdala
/ diagnostic imaging
Atrophy
Brain
/ diagnostic imaging
Case-Control Studies
Caudate Nucleus
/ diagnostic imaging
Cerebellar Cortex
/ diagnostic imaging
Cerebellum
/ diagnostic imaging
Cerebral Cortex
/ diagnostic imaging
Cerebral Infarction
/ diagnostic imaging
Coma
/ diagnostic imaging
Female
Gray Matter
/ diagnostic imaging
Hippocampus
/ diagnostic imaging
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Organ Size
Posterior Leukoencephalopathy Syndrome
/ diagnostic imaging
Putamen
/ diagnostic imaging
Sepsis
/ complications
Sepsis-Associated Encephalopathy
/ diagnostic imaging
Thalamus
/ diagnostic imaging
White Matter
/ diagnostic imaging
Brain dysfunction
Neuroimaging
Sepsis
Volume change
Volumetric analysis
Journal
Neurocritical care
ISSN: 1556-0961
Titre abrégé: Neurocrit Care
Pays: United States
ID NLM: 101156086
Informations de publication
Date de publication:
04 2020
04 2020
Historique:
pubmed:
13
6
2019
medline:
11
2
2021
entrez:
13
6
2019
Statut:
ppublish
Résumé
Sepsis-induced brain dysfunction (SIBD) is often encountered in sepsis patients and is related to increased morbidity. No specific tests are available for SIBD, and neuroimaging findings are often normal. In this study, our aim was to analyze the diagnostic value of volumetric analysis of the brain structures and to find out its significance as a prognostic measure. In this prospective observational study, brain magnetic resonance imaging (MRI) sections of 25 consecutively enrolled SIBD patients (17 with encephalopathy and 8 with coma) and 22 healthy controls underwent volumetric evaluation by an automated segmentation method. Ten SIBD patients had normal MRI, and 15 patients showed brain lesions or atrophy. The most prominent volume reduction was found in cerebral and cerebellar white matter, cerebral cortex, hippocampus, and amygdala, whereas deep gray matter regions and cerebellar cortex were relatively less affected. SIBD patients with normal MRI showed significantly reduced volumes in hippocampus and cerebral white matter. Caudate nuclei, putamen, and thalamus showed lower volume values in non-survivor SIBD patients, and left putamen and right thalamus showed a more pronounced volume reduction in coma patients. Volumetric analysis of the brain appears to be a sensitive measure of volumetric changes in SIBD. Volume reduction in specific deep gray matter regions might be an indicator of unfavorable outcome.
Sections du résumé
BACKGROUND
Sepsis-induced brain dysfunction (SIBD) is often encountered in sepsis patients and is related to increased morbidity. No specific tests are available for SIBD, and neuroimaging findings are often normal. In this study, our aim was to analyze the diagnostic value of volumetric analysis of the brain structures and to find out its significance as a prognostic measure.
METHODS
In this prospective observational study, brain magnetic resonance imaging (MRI) sections of 25 consecutively enrolled SIBD patients (17 with encephalopathy and 8 with coma) and 22 healthy controls underwent volumetric evaluation by an automated segmentation method.
RESULTS
Ten SIBD patients had normal MRI, and 15 patients showed brain lesions or atrophy. The most prominent volume reduction was found in cerebral and cerebellar white matter, cerebral cortex, hippocampus, and amygdala, whereas deep gray matter regions and cerebellar cortex were relatively less affected. SIBD patients with normal MRI showed significantly reduced volumes in hippocampus and cerebral white matter. Caudate nuclei, putamen, and thalamus showed lower volume values in non-survivor SIBD patients, and left putamen and right thalamus showed a more pronounced volume reduction in coma patients.
CONCLUSIONS
Volumetric analysis of the brain appears to be a sensitive measure of volumetric changes in SIBD. Volume reduction in specific deep gray matter regions might be an indicator of unfavorable outcome.
Identifiants
pubmed: 31187433
doi: 10.1007/s12028-019-00759-8
pii: 10.1007/s12028-019-00759-8
doi:
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
459-468Références
Iacobone E, Bailly-Salin J, Polito A, et al. Sepsis-associated encephalopathy and its differential diagnosis. Crit Care Med. 2009;37(10):S331–6.
pubmed: 20046118
doi: 10.1097/CCM.0b013e3181b6ed58
Girard TD, Jackson JC, Pandharipande PP, et al. Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Crit Care Med. 2010;38(7):1513.
pubmed: 20473145
pmcid: 3638813
doi: 10.1097/CCM.0b013e3181e47be1
Ely EW, Shintani A, Truman B, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004;291(14):1753–62.
doi: 10.1001/jama.291.14.1753
Iwashyna TJ, Ely EW, Smith DM, Langa KM. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA. 2010;304(16):1787–94.
pubmed: 20978258
pmcid: 3345288
doi: 10.1001/jama.2010.1553
Hopkins RO, Weaver LK, Collingridge D, et al. Two-year cognitive, emotional, and quality-of-life outcomes in acute respiratory distress syndrome. Am J Respir Crit Care Med. 2005;171(4):340–7.
pubmed: 15542793
doi: 10.1164/rccm.200406-763OC
Gofton TE, Young GB. Sepsis-associated encephalopathy. Nat Rev Neurol. 2012;8(10):557–66.
pubmed: 22986430
doi: 10.1038/nrneurol.2012.183
Polito A, Eischwald F, Maho AL, et al. Pattern of brain injury in the acute setting of human septic shock. Crit Care. 2013;17(5):R204.
pubmed: 24047502
pmcid: 4057119
doi: 10.1186/cc12899
Bartynski WS, Boardman JF, Zeigler ZR, Shadduck RK, Lister J. Posterior reversible encephalopathy syndrome in infection, sepsis, and shock. AJNR Am J Neuroradiol. 2006;27(10):2179–90.
pubmed: 17110690
Suchyta MR, Jephson A, Hopkins RO. Neurologic changes during critical illness: brain imaging findings and neurobehavioral outcomes. Brain Imaging Behav. 2010;4(1):22–34.
pubmed: 20503111
doi: 10.1007/s11682-009-9082-3
Orhun G, Tüzün E, Özcan PE, et al. Association between inflammatory markers and cognitive outcome in patients with acute brain dysfunction due to sepsis. Arch Neuropsychiatry. 2019;56(1):63.
Orhun G, Esen F, Ozcan PE, et al. Neuroimaging findings in sepsis-induced brain dysfunction: association with clinical and laboratory findings. Neurocrit Care. 2019;30(1):106–17.
pubmed: 30027347
doi: 10.1007/s12028-018-0581-1
Semmler A, Widmann CN, Okulla T, et al. Persistent cognitive impairment, hippocampal atrophy and EEG changes in sepsis survivors. J Neurol Neurosurg Psychiatry. 2013;84(1):62–9.
pubmed: 23134661
doi: 10.1136/jnnp-2012-302883
Heming N, Mazeraud A, Verdonk F, et al. Neuroanatomy of sepsis-associated encephalopathy. Crit Care. 2017;21(1):65.
pubmed: 28320461
pmcid: 5360026
doi: 10.1186/s13054-017-1643-z
Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39(2):165–228.
pubmed: 23361625
doi: 10.1007/s00134-012-2769-8
Sutter R, Chalela JA, Leigh R, et al. Significance of parenchymal brain damage in patients with critical illness. Neurocrit Care. 2015;23(2):243–52.
pubmed: 25650012
doi: 10.1007/s12028-015-0110-4
Ely EW, Inouye SK, Bernard GR, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA. 2001;286(21):2703–10.
doi: 10.1001/jama.286.21.2703
Sessler CN, Gosnell MS, Grap MJ, et al. The Richmond Agitation–Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002;166(10):1338–44.
pubmed: 12421743
doi: 10.1164/rccm.2107138
Posner JB, Plum F, Saper CB, Schiff N. Plum and Posner’s diagnosis of stupor and coma, vol. 17. Oxford: OUP USA; 2007.
Fischl B, Salat DH, Busa E, et al. Whole brain segmentation: automated labeling of neuroanatomical structures in the human brain. Neuron. 2002;33(3):341–55.
pubmed: 11832223
doi: 10.1016/S0896-6273(02)00569-X
Gunther ML, Morandi A, Krauskopf E, et al. The association between brain volumes, delirium duration, and cognitive outcomes in intensive care unit survivors: the VISIONS cohort magnetic resonance imaging study*. Crit Care Med. 2012;40(7):2022–32.
pubmed: 3697780
pmcid: 3697780
doi: 10.1097/CCM.0b013e318250acc0
Finke C, Kopp UA, Pajkert A, et al. Structural hippocampal damage following anti-N-methyl-D-aspartate receptor encephalitis. Biol Psychiatry. 2016;79(9):727–34.
pubmed: 25866294
doi: 10.1016/j.biopsych.2015.02.024
Finke C, Pruss H, Heine J, et al. Evaluation of cognitive deficits and structural hippocampal damage in encephalitis with leucine-rich, glioma-inactivated 1 antibodies. JAMA Neurol. 2017;74(1):50–9.
pubmed: 27893017
doi: 10.1001/jamaneurol.2016.4226
Yoneda Y, Mori E, Yamashita H, Yamadori A. MRI volumetry of medial temporal lobe structures in amnesia following herpes simplex encephalitis. Eur Neurol. 1994;34(5):243–52.
pubmed: 7995298
doi: 10.1159/000117051
Anderson VM, Fisniku LK, Khaleeli Z, et al. Hippocampal atrophy in relapsing-remitting and primary progressive MS: a comparative study. Mult Scler. 2010;16(9):1083–90.
pubmed: 20630904
doi: 10.1177/1352458510374893
Semmler A, Hermann S, Mormann F, et al. Sepsis causes neuroinflammation and concomitant decrease of cerebral metabolism. J Neuroinflammation. 2008;5:38.
pubmed: 18793399
pmcid: 2553764
doi: 10.1186/1742-2094-5-38
Peng QY, Wang YM, Chen CX, et al. Inhibiting the CD38/cADPR pathway protected rats against sepsis associated brain injury. Brain Res. 2018;1678:56–63.
pubmed: 29030054
doi: 10.1016/j.brainres.2017.09.029
Fu Q, Wu J, Zhou X-Y, et al. NLRP3/Caspase-1 pathway-induced pyroptosis mediated cognitive deficits in a mouse model of sepsis-associated encephalopathy. Inflammation. 2019;42:306–18.
pubmed: 30276509
doi: 10.1007/s10753-018-0894-4
Zaghloul N, Addorisio ME, Silverman HA, et al. Forebrain cholinergic dysfunction and systemic and brain inflammation in murine sepsis survivors. Front Immunol. 2017;8:1673.
pubmed: 29326685
pmcid: 5736570
doi: 10.3389/fimmu.2017.01673
Femminella GD, Ninan S, Atkinson R, et al. Does microglial activation influence hippocampal volume and neuronal function in Alzheimer’s disease and Parkinson’s Disease dementia? J Alzheimers Dis. 2016;51(4):1275–89.
pubmed: 27060942
doi: 10.3233/JAD-150827
Kondo A, Sugiura C, Fujii Y, et al. Fulminant sepsis-associated encephalopathy in two children: serial neuroimaging findings and clinical course. Neuropediatrics. 2009;40(4):157–61.
pubmed: 20135572
doi: 10.1055/s-0029-1243626