Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN 37232-8300, USA.
J Crit Care. 2010 Sep;25(3):538.e7-12. doi: 10.1016/j.jcrc.2010.05.004. Epub 2010 Jul 1.
Delirium affects 50% to 80% of intensive care unit (ICU) patients and is associated with increased risk of mortality. Given the paucity of data reporting the neuropathologic findings in ICU patients experiencing delirium, the purpose of this pilot, hypothesis-generating study was to evaluate brain autopsies in ICU patients who suffered from delirium to explore possible neuroanatomical correlates.
Using delirium databases at Vanderbilt University, we identified patients who had delirium in the ICU and subsequently died and received a brain autopsy during the same hospitalization. Brain autopsy reports were collected retrospectively on all 7 patients who met these criteria.
Patients' mean age was 55 (SD ± 8.4) years, and median number of days spent with delirium was 7 (± 5 interquartile range). In 6 (86%) of 7 patients, pathologic lesions normally attributed to hypoxia or ischemia were noted in the hippocampus, pons, and striatum. Hippocampal lesions represented the most common neuropathologic site of injury, present in 5 (71%) of 7 patients.
Hypoxic ischemic injury in multiple locations of the brain was a common finding. The biological plausibility of hippocampal lesions as a contributor to long-term cognitive impairment warrants postmortem investigation on a larger scale with comparison to patients not experiencing ICU delirium.
谵妄影响 50%至 80%的重症监护病房（ICU）患者，并与死亡率增加相关。鉴于报告 ICU 患者谵妄时神经病理学发现的数据很少，本初步、生成假说的研究旨在评估经历谵妄的 ICU 患者的脑尸检，以探索可能的神经解剖学相关性。
我们使用范德比尔特大学的谵妄数据库，确定了在 ICU 中出现谵妄并随后死亡且在同一住院期间接受脑尸检的患者。对所有符合这些标准的 7 名患者，我们回顾性地收集了脑尸检报告。
患者的平均年龄为 55（SD ± 8.4）岁，谵妄持续时间中位数为 7（± 5 四分位间距）天。在 7 名患者中的 6 名（86%）中，在海马体、脑桥和纹状体中观察到通常归因于缺氧或缺血的病理损伤。海马体损伤是最常见的神经病理损伤部位，在 7 名患者中的 5 名（71%）中存在。
大脑多个部位的缺氧缺血性损伤是常见发现。海马体损伤作为导致长期认知障碍的原因的生物学可能性需要更大规模的尸检调查，并与未经历 ICU 谵妄的患者进行比较。
