Review: Neuroimaging in Delirious ICU Patients


There is a case series on neuroimaging in delirious ICU patients titled ‘Neuroimaging in Delirious Intensive Care Unit Patients: A Preliminary Case Series Report’ by Alessandro Morandi and colleagues and freely available here. In this case series, the researchers have identified patients who were admitte to the intensive care unit and who underwent MRI scans. However they have very specific inclusion and exclusion criteria – patients should be admitted with shock or respiratory failure and subsequently develop delirium. There are a large number of exclusion criteria including focal neurological deficits. I think this will reduce the likelihood of these findings influencing the decision making process. The researchers find 8 cases which fit with the inclusion/exclusion criteria and the MRI findings are normal, some degree of cerebral atrophy or else various gradings of white matter hyperintensities. They conclude in this case series at least that the MRI didn’t influence the clinical decision making process in these patients with delirium and list the details of the case series in Table 1. However if the exclusion criteria had been dropped the findings may have been more interesting although such criteria and results may help to shape relevant protocols. The authors go on to suggest that the MRI scanner (1.5 Tesla) may not have been sensitive enough and that alternative neuroimaging approaches may yield results with more clinical utility. They cite one study in which

Assessment of brain perfusion using techniques such as arterial spin-labeling have identified perfusion deficits not assessed by structural MRI

The researchers also cite evidence for the efficacy of diffuse tensor imaging in this context and it will be interesting to see the results of further investigations using these neuroimaging approaches or else higher resolution MRI.

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