47 Incidence and pattern of brain lesions in paediatric septic shock patients. (4th October 2017)

• Record Type: Journal Article
• Authors: Sanz, D; D'Arco, F; Brierley, J
• Is Part Of: Archives of disease in childhood. Volume 102(2017)Supplement 3
• Page Start: A21
• Page End: A21
• Publication Date: 2017-10-04
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2017-084620.55
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Background: Brain injury is frequently observed during septic shock and may be primarily related to the direct effects of the septic insult on the brain or to secondary/indirect injuries (e.g., hypotension, hypoxemia and hyperglycaemia). We sought to assess incidence and pattern of brain lesions diagnosed by neuroimaging in paediatric septic shock patients. Methods: Retrospective descriptive hospital-based study included paediatric patients with a single episode of septic shock admitted to our paediatric intensive care unit (PICU) from January 2010 to December 2013. Results: 49 of 193 septic shock patients, with a median age 2.6 years (range 7 days-15 years), had a neuroimaging examination [computerised tomography (CT) only 22 (45%), magnetic resonance imaging (MRI) only 14 (29%) and both 13 (27%)]. Neuroimaging was normal in 16 patients (33%) and showed acute lesions in 20 patients (41%). The findings were: cerebral infarcts/hypoxic ischaemic injury in 8 (16%), cerebritis in 7 (14%), mixed lesions (ischaemia and cerebritis) in 1 (2%), posterior reversible encephalopathy syndrome (PRES) in 1 (2%), sinus venous thrombosis in 1 (2%) and haemorrhage in 2 (4%). The incidence of acute brain lesion in our septic shock cohort was 10% (20 of 193). EEG was recorded on 33 (67%) patients with neuroimaging and showed cerebral dysfunction in 28 (85%). EEG abnormalities were not predictive of neuroimaging alterations. Clinical neurological manifestations triggered neuroimaging investigation on 33 (67%) patients, being the most frequent decreased level of consciousness in 17 (35%), followed by seizures in 15 (31%). Conclusions: The diagnosis of brain dysfunction in septic shock patients relies essentially on neurological examination and neurological tests, such as EEG and neuroimaging. Neuroimaging can reveal acute intra-cerebral structural lesions and their reversibility, helping with management and prognosis. Longer term outcome studies are required to determine the full significance of our findings.