Evaluation and Management of Neurologic Complications of Sepsis

Neurologic complications are common in patients with sepsis and are associated with worse outcomes, increased length of stay, and long-term disability. This review outlines the major neurologic syndromes encountered in the context of sepsis, including sepsis-associated encephalopathy (SAE), seizures, cerebrovascular events, and ICU-acquired weakness due to critical illness polyneuropathy and critical illness myopathy.

We take a pragmatic, bedside-oriented approach to guide clinicians in evaluating septic patients with neurologic symptoms, most commonly presenting with altered mental status. We highlight diagnostic challenges when sedation, metabolic abnormalities, or medications confound the neurologic examination. Beginning with the clinical presentation and neurological examination, we review diagnostic pathways involving neuroimaging, continuous electroencephalogram (EEG), and laboratory studies to differentiate SAE from other neurologic conditions that may require specific treatment. Each neurologic complication is explored in detail, with emphasis on key exam findings, diagnostic strategies, and management principles. We also discuss the evolving understanding of central nervous system involvement in sepsis, including blood-brain barrier disruption, neuroinflammation, and microvascular injury as well as the long-term neurologic consequences of sepsis, including post-sepsis syndrome, cognitive impairment, increased risk of epilepsy, and increased stroke risk.

Neurological complications are frequent, clinically important, and often underrecognized in sepsis. By providing a structured, practical framework, this review supports early recognition, informed evaluation, and individualized management of neurologic complications in sepsis while also emphasizing the long-term impact of brain health.