Alterations in neurological function in head-injured patients experiencing major episodes of sepsis

More than 300 head injuries per year are evaluated by the neurotrauma team at the Maryland Institute of Emergency Medicine. Although most of the injuries follow motor vehicle accidents, a significant number also follow industrial accidents or acts of personal violence. Approximately 25% of patients with serious head injuries have associated episodes of sepsis - commonly because of other bodily injuries. We have identified a syndrome characterized by encephalopathy and/or accentuation of focal neurological dysfunction in head injury patients that presents during episodes of sepsis and that occurs in the absence of meningitis. Aggressive fever management alone does not reverse the encephalopathy. Neurodiagnostic studies reveal no focal changes. The intracranial pressure often remains normal or unchanged, and no improvement is evident after the empirical administration of standard doses of steroid or osmotic agents. The patient's neurological condition returns to base line once the sepsis has been eradicated. Ongoing investigations suggest an immunological basis for this abnormality.