CNS effects of sepsis

Multiple systems organ failure in association with sepsis has a distressingly high mortality rate. The spectrum of neurologic deficits and their incidence in septic patients remains poorly characterized. However, sepsis-associated CNS dysfunction appears to be as important a harbinger of excess mortality as renal or pulmonary dysfunction in septic patients. Brain microabscesses, disordered amino acid metabolism, alterations in brain neurotransmitters, and reduced cerebral blood flow and oxygen utilization have all been proposed as potential etiologies of septic encephalopathy. Unfortunately, much remains to be elucidated regarding the presentation and pathophysiology of septic encephalopathy before consideration of what constitutes appropriate therapy is likely to be fruitful. The dietary manipulation of plasma and brain amino acid profiles and refinement of therapeutic objectives of cardiovascular support to improve regional organ blood flow are but two promising areas of current investigation. At the present time, however, meticulous supportive therapy, appropriate antibiotics, and surgical drainage of a septic focus, when possible, represent optimal therapy.