Brain magnetic resonance imaging findings in patients with septic shock

Abstract

Introduction

The imaging of the brain of septic shock patients showing alterations in their neurological status are unremarkable most of the time. The current study provided findings from magnetic resonance imaging of the brain in septic shock.

Methods

Twenty patients with septic shock and brain dysfunction symptoms (acute alterations in mental status, delirium, coma, seizures and focal neurological deficits) [median age 54 years (26 to 65), APACHE II: 21 (15 to 29), SOFA: 8(1 to 15)] underwent brain magnetic resonance imaging (MRI) including gradient echo T1-weighted, fluid-attenuated inversion recovery (FLAIR), T2-weighted and diffusion isotropic images, and mapping of apparent diffusion coefficient. MRI findings were classi-fied based on lesion types and localizations. Blood was withdrawn sim-ultaneously for biomarker analysis. Neurological recovery of all patients were evaluated using Glasgow Outcome Scale (GOS) during discharge.

Results None of the patients’ brain imaging was normal at the time of the diagnosis of neurological alterations including mostly delirium. Twelve patients showed white matter hyperintensity (leukoencephalopathy), three patients showed ischemic lesions and posterior reversible encephalopathy syndrome findings were evident in three patients. Unexpected findings of cerebral atrophy not relating to age were seen in seven patients. The lesions were correlated with disease severity and GOS. No unexpected events were encountered during transport and MRI scan. Conclusions Our study indicates the importance of brain imaging in severe sepsis and septic shock. MRI can be an important imaging method in these patients, where lesions were associated with disease severity and poor outcome.