Versagen des zentralen, peripheren und vegetativen Nervensystems

摘要

Neurological complications following sepsis and multiorgan dysfunction are regular and common findings with a high prognostic relevance for intensive care patients. Main complications can be divided into complications of the central, peripheral and autonomic nervous system and the muscles. Central nervous system complications display disorders of consciousness (e. g. stupor or coma) or central motoric dysfunction (e. g. hemiparesis). They are caused by toxic-metabolic encephalopathy due to sepsis or liver or renal insufficiency, cerebrovascular disorders due to disseminated intravascular coagulation or other states with increased coagulation activity, by intracranial bleedings due to secondary bleeding disorders or reduced nutritive compensation (e. g. disorders of water and electrolyte balance). Complications of the peripheral nervous system include singular or multiple compression syndromes of peripheral nerves or critical illness polyneuropathy. The clinical symptoms include weaning difficulties and distal symmetrical paresis. The pathophysiology is complex and yet not well understood. The critical illness myopathy is often seen after concomittant use of corticosteroids. The autonomic nervous system is regularly involved in intensive care patients. Acute severe sympathetic hyperactivation might result in accompanying parasympathetic activation with danger of severe cardiac arrhythmia like the torsade de points. Further autonomic disorders include electrolyte changes (e. g. the SIADH), metabolic disorders and fever. Treatment of all neurological complications is based on symptom control and the treatment of the underlying disease.