Naidech Andrew M, Polnaszek Kelly L, Berman Michael D, Voss Joel L
Ken & Ruth Davee Department of Neurology, 303 East Chicago Ave, Ward 12-140, Chicago, IL, 60611, USA.
Department of Medical Social Sciences, 303 East Chicago Ave, Ward 19th Floor, Chicago, IL, 60611, USA.
Neurocrit Care. 2016 Jun;24(3):397-403. doi: 10.1007/s12028-015-0210-1.
Delirium symptoms are associated with later worse functional outcomes and long-term cognitive impairments, but the neuroanatomical basis for delirium symptoms in patients with acute brain injury is currently uncertain. We tested the hypothesis that hematoma location is predictive of delirium symptoms in patients with intracerebral hemorrhage, a model disease where patients are typically not sedated or bacteremic.
We prospectively identified 90 patients with intracerebral hemorrhage who underwent routine twice-daily screening for delirium symptoms with a validated examination. Voxel-based lesion-symptom mapping with acute computed tomography was used to identify hematoma locations associated with delirium symptoms (N = 89).
Acute delirium symptoms were predicted by hematoma of right-hemisphere subcortical white matter (superior longitudinal fasciculus) and parahippocampal gyrus. Hematoma including these locations had an odds ratio for delirium of 13 (95 % CI 3.9-43.3, P < 0.001). Disruption of large-scale brain networks that normally support attention and conscious awareness was thus associated with acute delirium symptoms.
Higher odds ratio for delirium was increased due to hematoma location. The location of neurological injury could be of high prognostic value for predicting delirium symptoms.
谵妄症状与后期更差的功能结局和长期认知障碍相关，但急性脑损伤患者谵妄症状的神经解剖学基础目前尚不确定。我们检验了这样一个假设，即血肿位置可预测脑出血患者的谵妄症状，脑出血是一种典型的患者通常不使用镇静剂或不存在菌血症的模型疾病。
我们前瞻性地纳入了90例脑出血患者，这些患者每天接受两次常规的谵妄症状筛查，采用经过验证的检查方法。利用基于体素的病变-症状映射和急性计算机断层扫描来确定与谵妄症状相关的血肿位置（N = 89）。
右侧半球皮质下白质（上纵束）和海马旁回的血肿可预测急性谵妄症状。包含这些位置的血肿发生谵妄的比值比为13（95%可信区间3.9 - 43.3，P < 0.001）。因此，正常支持注意力和意识的大规模脑网络的破坏与急性谵妄症状相关。
由于血肿位置，谵妄的比值比升高。神经损伤的位置对于预测谵妄症状可能具有很高的预后价值。
