ABSTRACT

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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脓毒症相关脑病和脓毒性脑炎：更新

摘要

介绍

脓毒症相关脑病 (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

2016-2020 年检索了 PUBMED 数据库。SAE 的临床表现是谵妄，SE 还以局灶性神经系统症状为特征。SAE 是由炎症引起的内皮/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。脓毒性栓塞 (SEE) 和脓毒性转移性脑炎 (SME) 的特征是局灶性缺血 (SEE) 和小脓肿 (SME)。SAE、SME 和 SEE 之间的连续性由成像技术和尸检记录。治疗的支柱是快速最佳抗生素治疗。实验方法侧重于炎症的调节、血脑屏障的稳定和膜/线粒体功能的恢复。

专家意见

最有前途的诊断方法是新的成像技术。对抗谵妄最重要的措施仍然是建立日常结构和足够的感官刺激。右美托咪定和褪黑激素似乎可以降低谵妄的发生率，它们在 SAE 和 SE 中的疗效仍有待确定。已获准用于其他适应症或可作为可能对 SAE 有效的食品补充剂的药物是他汀类药物、L-多巴/苄丝肼、β-羟基丁酸盐、棕榈酰乙醇酰胺和四环素或其他杀菌非溶解性抗生素。