This article is part of a series on Haemodynamics, edited by Claude Martin.

Review

Science review: The brain in sepsis – culprit and victim

Tarek Sharshar¹, Nicholas S Hopkinson², David Orlikowski¹ and Djillali Annane³

¹Attending Physician, Service de Réanimation Médicale, Hôpital Raymond Poincaré, Faculté de Médecine Paris Ile de France Ouest, Université de Versailles Saint-Quentin-en-Yvelines, Garches, France

²Attending Physician, Respiratory Muscle Laboratory, Royal Brompton and Harefield NHS Trust, Fulham Road, London, SW3 6NP, United Kingdom

³Head of ICU Department, Service de Réanimation Médicale, Hôpital Raymond Poincaré, Faculté de Médecine Paris Ile de France Ouest, Université de Versailles Saint-Quentin-en-Yvelines, Garches, France

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Critical Care 2005, 9:37-44doi:10.1186/cc2951

Published:	8 September 2004

Abstract

On one side, brain dysfunction is a poorly explored complication of sepsis. On the other side, brain dysfunction may actively contribute to the pathogenesis of sepsis. The current review aimed at summarizing the current knowledge about the reciprocal interaction between the immune and central nervous systems during sepsis. The immune-brain cross talk takes part in circumventricular organs that, being free from blood-brain-barrier, interface between brain and bloodstream, in autonomic nuclei including the vagus nerve, and finally through the damaged endothelium. Recent observations have confirmed that sepsis is associated with excessive brain inflammation and neuronal apoptosis which clinical relevance remains to be explored. In parallel, damage within autonomic nervous and neuroendocrine systems may contribute to sepsis induced organ dysfunction.