An Unexpected Precipitant of Delirium in a Patient with Developmental Delay

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Sandra Rao
Lawrence Jacobs


delirium, hydrocephalus, hallucinations, obstructive, diabetes, cognition, dementia



Delirium is an acute change in mental status with a fluctuating course. It has numerous precipitating factors that can be classified using the DIMS-R framework, including structural changes and metabolic disturbances. Delirium is often under-recognized and numerous screening tools have been developed to aid diagnosis.


A 52-year-old female with a history of cerebral palsy was admitted to hospital for hypernatremia and a first episode of hyperosmolar hyperglycemic state. Upon resolution of her metabolic disturbances, she developed visual hallucinations which prompted further investigations revealing a surprising diagnosis.


Visual hallucinations are the most common psychotic feature associated with delirium and are more likely to be associated with multiple medical conditions. Delirium is often multi-factorial and a full diagnostic workup, including imaging studies, should be considered to address all possible underlying etiologies. Effective treatment of delirium is dependent on treatment of all of its precipitants.

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