Introduction

Sepsis-associated encephalopathy (SAE) and septic encephalitis (SE) are associated with increased mortality, long-term cognitive impairment and focal neurological deficits.

Areas covered

The PUBMED database was searched 2016-2020. The clinical manifestation of SAE is delirium, SE additionally is characterized by focal neurological symptoms. SAE is caused by inflammation with endothelial/microglial activation, increase of permeability of the blood-brain-barrier, hypoxia, imbalance of neurotransmitters, glial activation, axonal and neuronal loss. Septic-embolic (SEE) and septic-metastatic encephalitis (SME) are characterized by focal ischemia (SEE) and small abscesses (SME). The continuum between SAE, SME and SEE is documented by imaging techniques and autopsies. The backbone of treatment is rapid optimum antibiotic therapy. Experimental approaches focus on modulation of inflammation, stabilization of the blood-brain barrier and restoration of membrane/mitochondrial function.

Expert opinion

The most promising diagnostic approaches are new imaging techniques. The most important measure to fight delirium remains establishment of daily structure and adequate sensory stimuli. Dexmedetomidine and melatonin appear to reduce the frequency of delirium, their efficacy in SAE and SE remains to be established. Drugs already licensed for other indications or available as food supplements which may be effective in SAE are statins, L-DOPA/benserazide, β-hydroxybutyrate, palmitoylethanolamide and tetracyclines or other bactericidal non-lytic antibiotics.

中文翻译：

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败血症相关性脑病和败血性脑炎：最新进展

介绍

败血症相关性脑病（SAE）和败血性脑炎（SE）与死亡率增加，长期认知障碍和局灶性神经功能缺损有关。

覆盖区域

搜索了PUBMED数据库2016-2020。SAE的临床表现为del妄，SE另外以局灶性神经系统症状为特征。SAE是由内皮/小胶质细胞激活，血脑屏障通透性增加，缺氧，神经递质失衡，神经胶质激活，轴突和神经元丢失引起的炎症引起的。化脓性栓塞（SEE）和化脓性转移性脑炎（SME）的特征是局灶性局部缺血（SEE）和小脓肿（SME）。SAE，SME和SEE之间的连续性通过成像技术和尸检记录。治疗的基础是快速的最佳抗生素治疗。实验方法集中于调节炎症，稳定血脑屏障和恢复膜/线粒体功能。

专家意见

最有前途的诊断方法是新的成像技术。对抗del妄症最重要的措施仍然是建立日常结构和适当的感觉刺激。右美托咪定和褪黑激素似乎减少了ir妄的频率，它们在SAE和SE中的疗效尚待确定。已获许可用于其他适应症或可作为食品补充剂在SAE中有效的药物是他汀类药物，L-DOPA /苄丝肼，β-羟基丁酸酯，棕榈酰乙醇酰胺和四环素或其他杀菌非溶解性抗生素。