Hematoma Locations Predicting Delirium Symptoms After Intracerebral Hemorrhage
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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.
KeywordsDelirium Quality of life Intracerebral hemorrhage Voxel-based lesion–symptom mapping
Andrew Naidech collaborated on the study design and hypothesis with Dr. Voss and co-wrote the manuscript. Kelly Polnaszek performed voxel-based lesion–symptom mapping and performed the statistical analysis. Michael Berman mapped the hematomas for voxel-based lesion–symptom mapping under Dr. Naidech and collected clinical and follow-up data. Joel Voss oversaw the voxel-based lesion–symptom mapping and statistical analysis.
Compliance with Ethical Standards
The research was supported by Award Number R00-NS069788 from the National Institute of Neurological Disorders and Stroke. The infrastructure for automated data retrieval was funded in part by the National Institutes of Health through a grant to Northwestern University’s Clinical and Translational Sciences (NUCATS) UL1RR025741. Dr. Naidech received partial salary support through a subcontract of National Institute for Neurological Disorders and Stroke contract HHSN271201200036C. After the first submission, Dr. Naidech was awarded HS023437 from the Agency for Healthcare Quality and Research. Effort for the revision was partly supported by that award. Part of this work was presented in abstract form at the 2014 American Delirium Society conference by invitation, and travel was partially offset by a grant from the Northwestern Memorial Foundation to Dr. Naidech.
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