Neurologiczne powikłania w przebiegu sepsy

*Katarzyna Wawrzyniak¹, Krzysztof Kusza¹, Sławomir Wawrzyniak²

Summary
Sepsis is best described as a generalized inflammatory response of the organism to infection. It may affect various organs and system; among the most serious complications are: septic encephalopathy (SE), critical illness polyneuropathy (CIP) and critical illness myopathy CIM).
SE belongs to early complications of the systemic inflammatory response syndrome (SIRS). A diffuse neurological deficit, disturbances of the cognitive function, convulsions, and/or coma may occur. The electroencephalogram is a sensitive indicator of the incidence and severity of the encephalopathy, but computed tomograms of the brain and cerebrospinal fluid findings are unremarkable. The prognosis is good. SE may reverse completely.
Critical illness polyneuropathy develops in association to multiple organ failure. Affected patients develop quadriplegia, because of distal muscle weakness, and respiratory failure. Deep tendon reflexes are usually absent, but they may be preserved in 20% of cases. A disturbance of microvasculatory function in peripheral nerves, causing primary axonal damage, may be responsible for the neuropathy. Electromyography reveals that conduction velocities and distal latencies are relatively intact, but there is a reduction in the compound muscle and the sensory nerve action potentials. CIP is best prevented by maintaining of glucose concentration between 4.4 and 6.1 mmol l^-1 and early administration of immunoglobulins.
CIM can be observed in four different forms: acute necrotic myopathy, acute rabdomyolysis, cachectic myopathy and loss of myosin thick filaments. Diffuse limb and respiratory muscle weakness are seen and weaning from a ventilator is not possible. EMG reveals fibrillation potentials and positive sharp waves indicating active denervation. Creatine kinase activity may be increased. There is no specific therapy. Corticosteroids and muscle relaxants should be avoided.

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