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.

Index: An index of the site can be found here. The page contains links to all of the articles in the blog in chronological order. Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s