Clinicians treating patients with stroke will be familiar with delirium: a syndrome characterised by the rapid onset of disorganised thought, inattention and altered level of consciousness, with a characteristically fluctuant course. Limited data suggest that up to a quarter of patients with stroke admitted to hospital are affected at some point.1 In addition to being distressing for patients and carers, delirium doubles the risk of death and dependency.2

If diagnosed correctly, delirium can be treated by searching for precipitating factors such as infection, altering predisposing factors such as medication and taking steps to reduce sensory impairment.3 However delirium is easily missed, partly due to its characteristic fluctuant course, which is especially …