The spectrum of sepsis-associated encephalopathy: a clinical perspective

Critical Care, Год журнала: 2023, Номер 27(1)

Опубликована: Окт. 5, 2023

Abstract Sepsis-associated encephalopathy is a severe neurologic syndrome characterized by diffuse dysfunction of the brain caused sepsis. This review provides concise overview diagnostic tools and management strategies for SAE at acute phase in long term. Early recognition diagnosis are crucial effective management. Because evaluation can be confounded several factors intensive care unit setting, multimodal approach warranted Diagnostic commonly employed include clinical evaluation, metabolic tests, electroencephalography, neuroimaging selected cases. The usefulness blood biomarkers injury remains limited. Clinical involves assessing patient's mental status, motor responses, brainstem reflexes, presence abnormal movements. Electroencephalography rule out non-convulsive seizures help detect patterns various severity such as generalized slowing, epileptiform discharges, triphasic waves. In patients with encephalopathy, value non-contrast computed tomography septic persistent seizures, and/or focal signs, magnetic resonance imaging detects more than 50% cases, mainly cerebrovascular complications, white matter changes. Timely identification treatment underlying infection paramount, along control systemic that may contribute to secondary injury. Upon admission ICU, maintaining appropriate levels oxygenation, pressure, balance crucial. Throughout ICU stay, it important mindful potential neurotoxic effects associated specific medications like midazolam cefepime, closely monitor seizures. efficacy targeted neurocritical during optimizing patient outcomes deserves further investigated. lead permanent sequelae. Seizures occurring increase susceptibility long-term epilepsy. Extended stays sepsis-associated linked functional disability neuropsychological sequelae, underscoring necessity surveillance comprehensive patients.

Язык: Английский

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Personalized neuron-specific enolase level based on EEG pattern for prediction of poor outcome after cardiac arrest

Annals of Intensive Care, Год журнала: 2025, Номер 15(1)

Опубликована: Янв. 17, 2025

After cardiac arrest (CA), the European recommendations suggest to use a neuron-specific enolase (NSE) level > 60 µg/L at 48-72 h predict poor outcome. However, prognostic performance of NSE can vary depending on electroencephalogram (EEG). The objective was determine whether threshold which predicts outcome varies according EEG patterns and effect electrographic seizures level. A retrospective study conducted in tertiary CA center, using prospective registry 155 adult patients comatose 72 after CA. were classified Westhall classification (benign, malignant or highly malignant). Neurological evaluated CPC scale 3 months (CPC 3-5 defining outcome). Participants 64 years old (IQR [53; 72,5]), 74% male. 83% out-of-hospital 48% initial shockable rhythm. Electrographic observed 5% 8% good patients, respectively (p = 0.50). blood levels significantly lower (median 20 IQR [15; 30]) compared group 110 µg/l [49;308], p < 0,001). Benign associated with 0.001). not increased as 0.15). In EEG, 45.2 predictive unfavorable 100% specificity higher sensitivity (70.8%) recommended cut-off (Se 66%). Combined seizures, 53.5 (77.7%) 66.6%). benign 78.2 (Sp 100%) 94%). AC, personalized approach pattern could improve this biomarker for prediction. Compared others no significant difference case seizures.

Язык: Английский

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Aberrant brain–heart coupling is associated with the severity of post cardiac arrest brain injury

Annals of Clinical and Translational Neurology, Год журнала: 2024, Номер 11(4), С. 866 - 882

Опубликована: Янв. 19, 2024

To investigate autonomic nervous system activity measured by brain-heart interactions in comatose patients after cardiac arrest relation to the severity and prognosis of hypoxic-ischemic brain injury.

Язык: Английский

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Multimodal assessment of favorable neurological outcome using NSE levels and kinetics, EEG and SSEP in comatose patients after cardiac arrest

Critical Care, Год журнала: 2025, Номер 29(1)

Опубликована: Апрель 11, 2025

Prognostic markers of good neurological outcome after cardiac arrest (CA) remain limited. We aimed to evaluate the prognostic value neuron-specific enolase (NSE), electroencephalogram (EEG) and somatosensory evoked potentials (SSEP) in predicting outcome, assessed separately combination. A retrospective study was conducted a tertiary CA center, using prospective registry. included all patients comatose discontinuation sedation with one EEG NSE blood measurement at 24, 48 or/and 72 h CA. The primary favorable three months, Cerebral Performance Categories (CPC) scale 1-2 defining outcome. Between January 2017 April 2024, 215 were included. Participants 63 years old (IQR [52-73]), 73% male. At 3 54 (25.1%) had Compared poor group, levels significantly lower group 24 (39 IQR[27-45] vs IQR[37-82]µg/L, p < 0.001), (26 [18-43] 107 [54-227]µg/L, 0.001) (20 µg/L IQR [15-30] 184 µg/l [60-300], 0,001). Normal (i.e., 17 µg/L) highly predictive positive (PPV) 71% despite sensitivity (Se) 9%. best cut-off values for below 45.5, 51.5 41.5 µg/L, yielding PPV 64%, 80% 83% sensitivities 74%, 93% 90%, respectively. decreasing trend between also (PPV 82%, Se 81%). benign pattern more frequently observed (87.1 14.9%, predicted 72% 94%. Regarding SSEPs, bilateral N20-baseline amplitude > 0.85 µV 75%, 100%). combination h, showed 96%, 76%). In CA, low or over time, high N20 are robust reducing prognosis uncertainty.

Язык: Английский

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Neural complexity and the spectral slope characterise auditory processing in wakefulness and sleep

European Journal of Neuroscience, Год журнала: 2023, Номер 59(5), С. 822 - 841

Опубликована: Дек. 15, 2023

Auditory processing and the complexity of neural activity can both indicate residual consciousness levels differentiate states arousal. However, how measures signal manifest in following environmental stimulation and, more generally, electrophysiological characteristics auditory responses change reduced remain under-explored. Here, we tested hypothesis that spectral slope would discriminate stages sleep wakefulness not only baseline electroencephalography (EEG) but also EEG signals stimulation. High-density was recorded 21 participants to determine spatial relationship between these pre- post-auditory Results showed 2-20 Hz range discriminated had a high correlation sleep. In wakefulness, strongly correlated 20-40 slope. resulted compared pre-stimulation modulated wakefulness. These findings confirm our markers arousal are sensitive sleep/wake during Our results have direct applications studies using probe functions consciousness.

Язык: Английский

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How can emotion and familiarity improve own-name oddball paradigms?

Neurophysiologie Clinique, Год журнала: 2025, Номер 55(3), С. 103050 - 103050

Опубликована: Янв. 31, 2025

The own-name paradigm is used to assess the depth of consciousness disorders in patients intensive care units. This auditory oddball elicits a positive event-related potential at 300 ms (named P300) after presentation deviant stimulus, here subject's own-name. P300 likely reflects neural processing novel which can trigger behavioral response. Presence response considered be indicative good prognosis for recovering wakefulness post-anoxic coma patients. However, its prognostic performance insufficient and some without will nevertheless awake. influenced by acoustic characteristics stimuli. use stimuli with an emotional valence may recruit additional brain networks besides attentional ones potentially improve value Moreover, better characterization recruitment different involved these responses would help understanding surface potentials. Here, we present two kind features that paradigms: "smiling" versus "rough" voice familiarity voice.

Язык: Английский

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Temporal Dynamics of Neural Synchrony and Complexity of Auditory EEG Responses in Post-Hypoxic Ischemic Coma

Resuscitation, Год журнала: 2025, Номер unknown, С. 110531 - 110531

Опубликована: Фев. 1, 2025

Язык: Английский

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Non-perinatal Hypoxic Ischemic Encephalopathy – Long Term Outcome and Clinico-radiological correlation

Brain Disorders, Год журнала: 2025, Номер unknown, С. 100217 - 100217

Опубликована: Март 1, 2025

Язык: Английский

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Robust EEG Characteristics for Predicting Neurological Recovery from Coma After Cardiac Arrest

Sensors, Год журнала: 2025, Номер 25(7), С. 2332 - 2332

Опубликована: Апрель 7, 2025

Clinically, patients in a coma after cardiac arrest are given the prognosis of "neurological recovery" to minimize discrepancies opinions and reduce judgment errors. This study aimed analyze background patterns electroencephalogram (EEG) signals from such identify key indicators for assessing coma. Standard machine learning models were applied sequentially as feature selectors filters. CatBoost demonstrated superior performance classification method compared other approaches. In addition, Shapley additive explanation (SHAP) values utilized rank importance features. Our results indicated that three different EEG features helped achieve fivefold cross-validation receiver-operating characteristic (ROC) 0.87. evaluation revealed functional connectivity contribute most at 70%. Among these, low-frequency long-distance (45%) was associated with poor prognosis, whereas high-frequency short-distance (25%) linked good prognosis. Burst suppression ratio is 20%, concentrated left frontal-temporal right occipital-temporal regions high thresholds (10/15 mV), demonstrating its strong discriminative power. research identifies electroencephalographic biomarkers, including burst thresholds, improve early objective assessments. By integrating (ML) algorithms, Gradient Boosting Models Support Vector Machines, SHAP-based visualization, robust screening methods ensure reliability predictions. These findings provide clinically actionable framework advancing neurological optimizing patient care.

Язык: Английский

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Continuous EEG in Day to Day Neurocritical Care – A Case Based Review

Current Treatment Options in Neurology, Год журнала: 2025, Номер 27(1)

Опубликована: Апрель 21, 2025

Язык: Английский

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