Delirium is a neuropsychiatric syndrome of acute/ subacute onset and fluctuating course characterized by altered attention and awareness which represents a change from the patient’s baseline cognitive functioning. Impairment in multiple cognitive domains, behavioural and emotional changes, perceptual disturbance and disrupted sleep–wake cycle are additional symptoms. This syndrome is frequent among hospitalized older people with an estimated prevalence of 25% and an incidence of 20%–29%. Cancer patients are particularly vulnerable to suffer from delirium with reported rates ranging from 57% to 85%. At the emergency room delirium is diagnosed in 8%–17% of the total amount of admissions and it was associated with a 70% increased risk of sixth-month mortality after the diagnosis. Glioblastoma multiforme (GBM) is a grade IV neoplasia of astrocytic differentiation associated with poor outcomes and high mortality rates. Despite representing more than 60% of the whole primary brain tumours, it remains a rare condition with an estimated incidence of 3.19 per 10 000. GBM usually manifests with neurological symptoms and delirium has been reported with previously diagnosed GBM. Here we report two cases in which delirium was the first presenting feature of GBM. In the first case, a previously healthy 82-year-old Caucasian female was observed with fatigue, irritability, insomnia and anorexia for 3–4 weeks. She was the principal caregiver of her husband (who had moderate dementia) and during the last years she remained very supportive, being able to manage all the domestic activities, providing him the medication and supervising his behaviour. The daughter reported that her mother had increasing signs of caregiver burnout and she was particularly concerned as during the last week she had fluctuating episodes of disorganized speech and disorientation (detected during phone calls). The clinical examination (including the mental examination and a brief neurological examination) was unremarkable apart from mild psychomotor retardation and deficit in sustained attention. In the second case, a 72-year-old Caucasian female with a history of recurrent depressive episodes (since adolescence) who had been stable for several years was brought to the emergency psychiatric room in a state of abulia, social isolation and negativism for the previous 3 weeks. For unknown reasons, she had stopped the psychiatric medication (venlafaxine 75 mg once daily and diazepam 5 mg once daily) 1 week before the symptoms became apparent. With family supervision she restarted the correct posology during the following weeks but her clinical condition did not improve. At admission she presented with a perplexed posture, could not follow the interview due to severe inattention and responded with a low output and whispered disorganized speech. Both patients underwent a routine workup (blood count, biochemistry, urine analysis, electrocardiogram) which was unremarkable. A brain computed tomography (CT) scan was subsequently ordered to clarify the cause of the acute changes in mental state. In both cases a voluminous frontal lesion was detected (Fig. 1). The patients were referred to neurosurgery and following removal of the lesions the definite anatomical-pathological diagnosis was GBM. In these two cases delirium was the clinical presentation of an underlying rare brain disorder which could only be identified with a neuroimaging exam. However, although delirium is a manifestation of acute brain dysfunction in most patients there is no identifiable primary involvement of the brain. Therefore, in daily practice most patients presenting with delirium are routinely tested with blood and urine analysis to identify the most common causes underlying this syndrome (e.g. systemic infection, electrolyte imbalance, endocrine changes). In contrast, the use of neuroimaging exams (CT or magnetic

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谵妄为多形性胶质母细胞瘤的主要表现：附2例报告

谵妄是一种急性/亚急性发作和波动过程的神经精神综合征，其特征是注意力和意识的改变，这代表了患者基线认知功能的变化。多个认知领域的损伤、行为和情绪变化、知觉障碍和睡眠-觉醒周期中断是额外的症状。这种综合征在住院老年人中很常见，估计患病率为 25%，发生率为 20%–29%。癌症患者特别容易患谵妄，据报道发生率从 57% 到 85% 不等。在急诊室，谵妄被诊断出占总入院人数的 8%–17%，并且与诊断后第 6 个月死亡风险增加 70% 相关。多形性胶质母细胞瘤 (GBM) 是一种星形细胞分化的 IV 级瘤形成，与不良预后和高死亡率相关。尽管占整个原发性脑肿瘤的 60% 以上，但它仍然是一种罕见的疾病，估计发病率为 3.19/10 000。GBM 通常表现为神经系统症状，据报道，先前诊断出的 GBM 会出现谵妄。在这里，我们报告了两个案例，其中谵妄是 GBM 的第一个表现特征。在第一个案例中，观察到一名先前健康的 82 岁白人女性出现疲劳、易怒、失眠和厌食 3-4 周。她是她丈夫（患有中度痴呆症）的主要照顾者，在过去的几年里，她一直非常支持她，能够处理所有的家务，为他提供药物并监督他的行为。女儿报告说，她的母亲有越来越多的照顾者倦怠的迹象，她特别担心，因为在上周她有波动的言语混乱和迷失方向（在电话中发现）。临床检查（包括精神检查和简短的神经系统检查）除轻度精神运动迟缓和持续注意力缺陷外，没有什么特别之处。在第二个案例中，一名 72 岁的白人女性，有反复抑郁发作史（从青春期开始），病情稳定数年，被带到精神病急诊室，处于无能状态、社会孤立和消极情绪状态。前 3 周。由于不明原因，在症状出现前 1 周，她已停止服用精神科药物（文拉法辛 75 毫克，每天一次，地西泮 5 毫克，每天一次）。在家人的监督下，她在接下来的几周内重新开始了正确的剂量学，但她的临床状况没有改善。入院时，她表现出困惑的姿势，由于严重的注意力不集中而无法跟上采访，并以低输出和低声杂乱无章的言语回应。两名患者均接受了常规检查（血细胞计数、生化、尿液分析、心电图），但均无异常。随后下令进行脑计算机断层扫描 (CT) 扫描以阐明精神状态急剧变化的原因。在这两种情况下，都检测到了大量的额叶病变（图 1）。患者被转诊至神经外科，切除病灶后，明确的解剖病理诊断为 GBM。在这两种情况下，谵妄是一种潜在的罕见脑部疾病的临床表现，只能通过神经影像学检查来识别。然而，虽然谵妄是大多数患者急性脑功能障碍的一种表现，但没有可识别的大脑原发受累。因此，在日常实践中，大多数谵妄患者会定期接受血液和尿液分析，以确定该综合征最常见的原因（例如全身感染、电解质失衡、内分泌变化）。相比之下，使用神经影像学检查（CT 或磁 在这两种情况下，谵妄是一种潜在的罕见脑部疾病的临床表现，只能通过神经影像学检查来识别。然而，尽管谵妄是大多数患者急性脑功能障碍的一种表现，但没有可识别的大脑原发受累。因此，在日常实践中，大多数谵妄患者会定期接受血液和尿液分析，以确定该综合征最常见的原因（例如全身感染、电解质失衡、内分泌变化）。相比之下，使用神经影像学检查（CT 或磁 在这两种情况下，谵妄是一种潜在的罕见脑部疾病的临床表现，只能通过神经影像学检查来识别。然而，尽管谵妄是大多数患者急性脑功能障碍的一种表现，但没有可识别的大脑原发受累。因此，在日常实践中，大多数谵妄患者会定期接受血液和尿液分析，以确定该综合征最常见的原因（例如全身感染、电解质失衡、内分泌变化）。相比之下，使用神经影像学检查（CT 或磁 在日常实践中，大多数谵妄患者会定期接受血液和尿液分析，以确定该综合征的最常见原因（例如全身感染、电解质失衡、内分泌变化）。相比之下，使用神经影像学检查（CT 或磁 在日常实践中，大多数谵妄患者会定期接受血液和尿液分析，以确定该综合征的最常见原因（例如全身感染、电解质失衡、内分泌变化）。相比之下，使用神经影像学检查（CT 或磁