Schmidley J W, Messing R O
Stroke. 1984 Sep-Oct;15(5):883-5. doi: 10.1161/01.str.15.5.883.
Patients with infarctions in the territory of the right middle cerebral artery (RMCA) sometimes present with an agitated confusional state. We reviewed clinical data on 46 patients with RMCA infarcts and compared neurologic findings in patients with and without agitated confusion. Neither of the two patients presenting with agitated confusion showed obvious localizing neurologic signs; subtle motor, visual field and sensory deficits referable to the infarcted regions were present, but difficult to elicit because of the mental state. In contrast, all but one of the patients without agitated confusion had prominent motor and sensory signs. Infarction of the RMCA territory may cause agitated confusion in patients without prominent localizing signs; the initial neurologic findings may suggest a metabolic encephalopathy. However, the possibility of a cerebrovascular cause should not be dismissed in confused and agitated patients who have no definite lateralizing signs.
右侧大脑中动脉（RMCA）供血区域梗死的患者有时会出现激越性谵妄状态。我们回顾了46例RMCA梗死患者的临床资料，并比较了有激越性谵妄和无激越性谵妄患者的神经学表现。出现激越性谵妄的2例患者均未表现出明显的定位性神经体征；存在与梗死区域相关的轻微运动、视野和感觉障碍，但由于精神状态而难以引出。相比之下，除1例患者外，无激越性谵妄的患者均有明显的运动和感觉体征。RMCA供血区域梗死可能导致无明显定位体征的患者出现激越性谵妄；最初的神经学表现可能提示代谢性脑病。然而，对于没有明确定位体征的意识模糊和激越的患者，不应排除脑血管病因的可能性。
