Clinical Report: Lumbar Puncture Pressure and Delirium in HSV Encephalitis
Overview
This study examines the relationship between lumbar puncture (LP) opening pressure and delirium in patients with herpes simplex virus (HSV) encephalitis. Findings indicate that elevated LP opening pressure correlates with increased delirium odds and reduced functional network hub integrity in key brain regions.
Background
Herpes simplex virus encephalitis is the most common sporadic viral encephalitis, often leading to severe complications such as delirium. Understanding the role of intracranial pressure (ICP) in delirium can inform better management strategies and improve patient outcomes. This study explores the potential mediating effects of LP opening pressure on delirium through disruptions in brain network functionality.
Data Highlights
Measure
Delirium Group
Non-Delirium Group
p-value
LP Opening Pressure (cmH₂O)
23.5 ± 4.8
15.5 ± 3.2
< 0.001
Delirium Odds Ratio
1.86
-
< 0.001
Key Findings
40% of HSV encephalitis patients developed delirium.
Higher LP opening pressure was significantly associated with delirium (23.5 ± 4.8 vs. 15.5 ± 3.2 cmH₂O; p < 0.001).
Elevated LP opening pressure increased delirium odds (OR 1.86; 95% CI 1.58–2.11; p < 0.001).
Degree centrality (DC) was significantly reduced in the right amygdala, right hippocampus, left insula, and left precuneus in delirium patients.
LP opening pressure inversely correlated with DC in key brain regions.
Mediation analyses confirmed partial mediation by DC in specific brain regions.
Clinical Implications
Monitoring LP opening pressure may provide valuable insights into delirium risk in HSV encephalitis patients. Clinicians should consider ICP management and functional network integrity as potential targets for intervention to mitigate delirium. Further research is needed to validate these findings and explore targeted preventive strategies.
Conclusion
The study suggests a potential link between LP opening pressure and delirium in HSV encephalitis, mediated by disruptions in brain network functionality. These findings highlight the need for further investigation into ICP management as a strategy for delirium prevention.
