The use of cerebral imaging for investigating delirium aetiology

Published:February 07, 2018DOI:


      • Thirty-three per cent of patients with delirium underwent CT brain scans.
      • Eleven per cent of the CT brain scans were positive.
      • In some patients MRI brain added value in determining underlying pathology.
      • Ischaemia was the most common lesion detected by MRI but undetected by CT brain.



      This study aims to investigate the frequency and patterns of use of cerebral imaging in delirium and to describe pathological changes associated with delirium using computed tomography (CT) and magnetic resonance imaging (MRI).


      This retrospective observational study included patients with delirium admitted to a tertiary hospital (The Royal Melbourne Hospital, Australia) between January 2015 and August 2016. Data on cerebral imaging was collected and positive imaging findings were defined as: Acute or subacute infarct, haemorrhage, abscess, neoplasm, vasculitis, posterior reversible encephalopathy syndrome, encephalitis, acute demyelination, or fat embolism.


      There were 1653 (5% of 32,725) patients with delirium (median age 80 years, inter-quartile range 71–86, 54% male). Thirty-three percent (N = 538) had cerebral imaging (CT only: N = 457, MRI only: N = 10, both: N = 71). In 11% (N = 57) of patients, CT brain scans were positive. MRI brain was completed in 17 patients with a positive CT (17/57), changing the diagnosis in two cases. Fifty-four patients with negative CT scans also had MRI brain; 33% (N = 18) of these were positive. Younger patients were more likely to have MRI compared to CT brain scan. Patients admitted to a neurology unit were more likely to have cerebral imaging.


      Use of CT brain was common in delirium patients, with an 11% rate of positive findings. Fewer patients had MRI brain scans, which added diagnostic information in some cases. Future studies are needed to define the significance of cerebral imaging in delirium management and establish guidelines for its use.


      CT (computed tomography), MRI (magnetic resonance imaging)


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        • Inouye S.K.
        • Westendorp R.G.
        • Saczynski J.S.
        Delirium in elderly people.
        Lancet. 2014; 383: 911-922
        • Laurila J.V.
        • et al.
        Predisposing and precipitating factors for delirium in a frail geriatric population.
        J Psychosom Res. 2008; 65: 249-254
      1. Clinical practice guidelines for the management of delirium in older people.
        in: Clinical Epidemiology and Health Service Evaluation Unit and Delirium Clinical Guidelines Expert Working Group. 2006 (Available from:)
      2. Guidelines for the prevention, diagnosis and management of delirium in older people.
        in: British Geriatrics Society and Royal College of Physicians. RCP, London2006
        • Maher S.
        Delirium in older people.
        Australian and New Zealand Society for Geriatric Medicine, 2012
        • Lai M.M.Y.
        • Niam D.M.W.T.
        Intracranial cause of delirium: computed tomography yield and predictive factors.
        Intern Med J. 2010; 42: 422-427
        • Hufschmidt A.
        • Shabarin V.
        Diagnostic yield of cerebral imaging in patients with acute confusion.
        Acta Neurol Scand. 2008; 118: 245-250
        • Theisen-Toupal J.
        • et al.
        Diagnostic yield of head computed tomography for the hospitalised medical patient with delirium.
        J Hosp Med. 2014; 9: 497-501
        • Vijayakrishnan R.
        • Ramasubramanian A.
        • Dhand S.
        Utility of head CT scan for acute inpatient delirium.
        Hosp Top. 2015; 93: 9-12
        • Hardy J.E.
        • Brennan N.
        Computerized tomography of the brain for elderly patients presenting to the emergency department with acute confusion.
        Emerg Med Australas. 2008; 20: 420-424
        • West W.M.
        • et al.
        Acute computed tomography findings in patients with acute confusion of non-traumatic aetiology.
        West Indian Med J. 2011; 60: 571-575
        • Leong L.B.
        • et al.
        Identifying risk factors for an abnormal computed tomographic scan of the head among patients with altered mental status in the Emergency Department.
        Eur J Emerg Med. 2010; 17: 219-223
        • Kishi Y.
        • et al.
        Delirium in critical care unit patients admitted through an emergency room.
        Gen Hosp Psychiatry. 1995; 17: 371-379
        • Algethamy H.M.
        • et al.
        Added value of MRI over CT of the brain in intensive care unit patients.
        Can J Neurol Sci. 2015; 42: 324-332
        • Rizzo L.
        • et al.
        Cerebral venous thrombosis: role of CT, MRI and MRA in the emergency setting.
        Radiol Med. 2010; 115: 313-325
        • Sutter R.
        • Kaplan P.
        What to see when you are looking at confusion: a review of the neuroimaging of acute encephalopathy.
        J Neurol Neurosurg Psychiatry. 2015; 86: 446-459
        • Carin-Levy G.
        • et al.
        Delirium in acute stroke: screening tools, incidence rates and predictors: a systematic review.
        J Neurol. 2012; 259: 1590-1599
        • Morandi A.
        • et al.
        Neuroimaging in delirious intensive care unit patients: a preliminary case series report.
        Psychiatry (Edgmont). 2010; 7: 28-33
        • Reiser M.F.
        • Semmler W.
        • Hricak H.
        Magnetic resonance tomography.
        Springer-Verlag Berlin and Heidelberg GmbH & Co. KG, Germany2007
        • Lipowski Z.J.
        Delirium in the elderly patient.
        N Engl J Med. 1989; 320: 578-582
        • Katznelson R.
        • et al.
        Hospital administrative database underestimates delirium rate after cardiac surgery.
        Can J Anaesth. 2010; 57: 898-902
        • Naughton B.J.
        • et al.
        Computed tomography scanning and delirium in elder patients.
        Acad Emerg Med. 1997; 4: 1107-1110
        • Trzepacz P.T.
        The neuropathogenesis of delirium: a need to focus our research.
        Psychosomatics. 1994; 35: 374-391
        • Figiel G.S.
        • et al.
        Brain magnetic resonance imaging findings in ECT-induced delirium.
        J Neuropsychiatry Clin Neurosci. 1990; 2: 53-58
        • Yokota H.
        • et al.
        Regional cerebral blood flow in delirium patients.
        Psychiatry Clin Neurosci. 2003; 57: 337-339