Abstract

Delirium cases, referred to neurology from two hospitals, were prospectively collected over 6 months. Were those referred with delirium suffering from it? Would there be additional cases of delirium, unsuspected by referrers, who presented with unusual manifestations of delirium? How had such cases been investigated and managed (NICE guidelines) and what diagnoses would emerge? Twenty-nine people (17 men, average age 66) were diagnosed with delirium after neurology review; 11 unrecognised by referrers and considered to have, for example, memory difficulty, leg weakness, postural intolerance, behavioural problems, dementia, back pain and tremor. Three cases referred with delirium were found to have isolated dysmnesia, receptive dysphasia or prosopagnosia after neurology review. Information from relatives and nurses was most propitious in aiding the diagnosis of delirium and its aetiology; medication (13) and alcohol (5) were often overlooked. Additional tests were seldom required but notably two LPs revealed bacterial meningitis. Wernicke's encephalopathy (4), lewy Body dementia (3), sub-dural, primary hypereosinophilic syndrome, ADEM, bacterial meningitis (2) and anti-potassium antibody encephalopathy emerged as diagnoses, some with specific treatment but only one person's management adhered to generic NICE guidelines. Abnormal investigations had not invariably been acted upon. Neurology can contribute greatly to recognition and treatment of delirium.