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Brain autopsy findings in intensive care unit patients previously suffering from delirium: a pilot study
David R Janz1, Ty W Abel, James C Jackson
1Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN 37232-8300, USA. david.janz@vanderbilt.edu
Insights
Brain autopsies revealed hypoxic-ischemic injury in intensive care unit (ICU) patients with delirium. Hippocampal lesions were common, suggesting a link between brain injury and delirium.
Area of Science:
- Neuropathology
- Intensive Care Medicine
- Neuroscience
Background:
- Delirium is prevalent in intensive care units (ICUs), affecting up to 80% of patients.
- Delirium is linked to higher mortality rates.
- Neuropathologic data in ICU delirium patients is scarce.
Purpose of the Study:
- To investigate neuropathologic findings in ICU patients who experienced delirium.
- To explore potential neuroanatomical correlates of ICU delirium through brain autopsies.
Main Methods:
- Retrospective analysis of brain autopsy reports from 7 ICU patients with delirium.
- Patients were identified from delirium databases at Vanderbilt University.
Main Results:
- The average age of patients was 55 years, with a median of 7 days of delirium.
- Hypoxic-ischemic lesions were observed in the hippocampus, pons, and striatum in 86% of patients.
- Hippocampal lesions were the most frequent finding, present in 71% of cases.
Conclusions:
- Hypoxic-ischemic brain injury is a common finding in ICU patients with delirium.
- Hippocampal lesions may contribute to long-term cognitive impairment.
- Further large-scale postmortem studies are warranted to compare ICU delirium patients with controls.
Purpose:
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.
Materials And Methods:
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.
Results:
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.
Conclusions:
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.
