Delirium in Elderly Patients:Frequency and Precipitants in a Tertiary Hospital Setting.

OBJECTIVE: There is paucity of information on delirium in sub-Saharan Africa (SSA) particularly in the older persons (>60 years of age), leaving questions about the burden of the disease in an environment with lower health care standards. In this article, we set out to determine the frequency, precipitants and symptomatology of delirium in elderly patients admitted into medical wards in a teaching hospital in South-West Nigeria. METHODS: This was a descriptive study involving a pre-planned sample of one hundred and fifty patients aged 60 years and over, assessed for cognitive impairment and delirium using the previously validated IDEA cognitive screen, and the Confusion Assessment Method (CAM) respectively. Diagnosis of delirium was made using the CAM and DSM-IV criteria. RESULTS: Delirium was diagnosed in 32 patients giving a frequency of 21.3% (95%CI: 14.7-30.0%). Patients with delirium were significantly older (p<0.05). A quarter of the patients had dementia. Hypertension was a notable co-morbid condition. All the patients had altered sleep wake cycle, inattention, disorientation, and altered consciousness. Neurological diseases were the most common precipitant. There was a good agreement between the DSM-IV and CAM diagnoses. CONCLUSION: Delirium is common in hospitalised elderly patients particularly those with neurological diseases. Co-morbidities like hypertension, dementia, and depression should be looked for in delirious elderly patients.

Cerebral Venous Thrombosis, Protein S Deficiency and Pregnancy Triad:A Case Report.

BACKGROUND: Cerebral venous sinus thrombosis (CVT) is an uncommon cause of stroke that is more prevalent among young adults and more so among women. Being an unusual site for venous thrombosis, its occurrence usually implies the presence of a thrombophilic disorder, inherited or acquired. Occasionally, multiple inherited or acquired risk factors for hypercoagulability may co-exist. In this report we present a case manifesting the triad of protein S deficiency, pregnancy and imaging-confirmed extensive CVT. CASE PRESENTATION: A 28-year-old primigravid woman presented with acute onset of severe headache, protracted vomiting, reduced consciousness, spastic quadriparesis and bilateral papilloedema. The serum D-Dimer assay was markedly elevated and brain computerized tomography scan revealed extensive thrombus involving superior and inferior sagittal sinuses, the straight sinus, the confluence of sinuses as well as the left transverse sinus. A hypercoagulability panel revealed protein S deficiency. She was treated with cerebral decompression and subcutaneous enoxaparin with remarkable clinical improvement in muscle power and consciousness level. Her pregnancy and delivery were otherwise normal. CONCLUSION: Hypercoagulability should be suspected in a pregnant woman presenting with stroke and a high index of suspicion is needed in making accurate diagnosis. The case highlights the importance of brain imaging in confirming the diagnosis.