Neurological Complications in Sepsis

Abstract

Background: Sepsis is a medical emergency that requires immediate assessment and management. Sepsis can affect patients at any age group which increases the number of sepsis cases. The utilization of advanced diagnostic technologies and the implementation of best practice guidelines led to an increase in the number of sepsis survivors. Yet, those who survive sepsis suffer from post-sepsis syndrome after hospital discharge. This syndrome involves deficits in multiple systems, including immune, cognitive, psychiatric, cardiovascular, and renal system changes. These changes have a determinantal effect on sepsis survivors leading to fatigue, pain, visual disturbances, gastrointestinal problems, and neuropsychiatric problems. The aim of this paper is to shed light onto the neurological changes after sepsis.

Methods: A literature review on neurological complications post sepsis was conducted. Literature review findings were presented in a lecture format, starting with a case discussion to guide the audience’s attention to the neurological complications associated with sepsis. How these complications manifest among sepsis survivors and what are the most common forms of neurological complications post sepsis. As well as the impact of these neurological changes on the quality of life for sepsis survivors.

Result: The literature review revealed that patients who survive sepsis suffer from various cognitive disturbances such as Sepsis Associated Delirium (SAD) in 53% of the cases. The neurological symptoms in SAD range from agitation, hallucinations, lack of focus, disturbance of the sleep–wake-cycle, and coma. 37% of patients with sepsis recover from neurological symptoms within four weeks after the initial onset. Sepsis Associated Encephalopathy (SAE) is another common form of neurological changes post sepsis that occurs due to changes in cerebral perfusion with exclusion of central nervous system infection, structural brain injury, and metabolic causes. SAE is caused by inflammation that increases endothelial permeability of the blood-brain-barrier, leading to hypoxia, imbalance of neurotransmitters, glial activation causing axonal and neuronal loss. In addition, depressive symptoms were found in 28% of sepsis survivors. Another study included in this review showed that age is a serious risk factor for developing cognitive impairment post sepsis. Patients at the age of 65 years and older who survive sepsis are at 10-fold increase the incidence rate of cognitive impairment. The most common form of cognitive impairment is disturbance of memory and dementia. A prospective observational study that assessed the quality-of-life post sepsis indicated 60% of patients who survived sepsis had difficulties in normal activities, and 56% had pain.

Conclusion: Sepsis is common and is associated with various neurological sequel affecting cognitive and physical functions of sepsis survivors. Neurological complications post sepsis may persist for months or years after patients’ recovery. To effectively manage those patients, it is pivotal to investigate and eliminate the possibility of a primary central nervous system pathology that might cause neurological alterations. Regular screening of sepsis survivors on symptoms of depression, chronic pain and post-traumatic stress within one year after ICU should be considered.