Monitorization of Acute Brain Dysfunction in Critical Illness

Abstract

E-pos ta: esenf@istanbul.edu.tr Tel.: +90 532 362 77 64 OZ Akut beyin disfonksiyonu, yogun bakim unitesinde yaygin olarak gorulen ve deliryumdan komaya kadar degisen norolojik degisikliklerin izlendigi klinik bir tablodur. Kritik hastalarda genellikle sepsis sirasinda ortaya cikan bu sendrom “sepsis iliskili ensefalopati” olarak da adlandirilir ve bu durum, mortalite, morbidite artisi ve uzun donem kognitif bozukluk gelismesi ile iliskili oldugu icin onemlidir. Kritik hastalarda beyin fonksiyonlarinin monitorizasyonu, ayrintili norolojik muayene ile baslamalidir ve degerlendirme sirasinda norolojik yanitlari degistirebilecek sedatif ilaclarin etkileri dikkate alinmalidir. Beyin goruntuleme yontemleri ve elektrofizyolojik incelemeler ise norolojik muayeneyi tamamlayan tani yontemleridir. Bilgisayarli tomografi, yapisal intraserebral lezyonlarin tanisini saglarken, manyetik rezonans goruntuleme, sepsis iliskili ensefalopatinin primer patolojik mekanizmalarina ve beyinde gelisen yapisal degisikliklere iliskin onemli bilgiler saglar. Elektroensefalografi kullanimi ile akut beyin disfonksiyonunun tanisi ve prognozu hakkinda kanitlar elde edilebilir. Norolojik biyomarkirlarin tanida ve prognozun tayin edilmesinde yararli olabilecegi dusunulmekle beraber bu konuda daha fazla arastirmaya ihtiyac vardir. Anahtar Kelimeler: Akut beyin disfonksiyonu, sepsis iliskili ensefalopati, norolojik muayene, beyin manyetik rezonans goruntuleme, elektroensefalografi, norolojik biyomarkirlar SUMMARY Acute brain dysfunction is a clinical condition which is commonly observed in intensive care units and exhibits neurological changes ranging from delirium to coma. Typically observed during sepsis in critical patients, this syndrome is also named as “sepsis-associated encephalopathy” and this situation is of significance since it is related to mortality, increase of morbidity and longterm cognitive impairment. Monitorization of brain functions in critically ill patients should be commenced with detailed neurological examination and effects of sedative drugs, which can alter neurological responses during evaluation, should be taken into consideration. On the other hand, brain imaging methods and electrophysiological examinations are diagnostic procedures which complement neurological examination. While computed tomography enables diagnosis of structural intracerebral lesions, magnetic resonance imaging provides important information on primary pathological mechanisms of sepsisassociated encephalopathy and structural alterations developing in the brain. Evidence of diagnosis and prognosis of acute brain dysfunction can be acquired through use of electroencephalography for. Although it was believed that neurological biomarkers can be useful in determination of diagnosis and prognosis, further studies are needed in this subject.