- Around one third of stroke patients in an acute ward develop delirium. The duration is uncertain although around *69% may still have delirium at four weeks post-stroke
- Delirium is characterised by sudden onset, altered consciousness, disorganised thinking and distractibility. Delirium can sometimes cause hallucinations.
- Delirium may be caused by stroke, however there are often treatable underlying conditions such as infection, electrolyte imbalance, alcohol withdrawal and adverse effects of medication.
- Approximately one in eight stroke patients will have delirium. This increases with age.
- There are two types of delirium:
- “hypoactive” which presents as depression and sedation
- “hyperactive” which presents as agitation and anxiety
- Hallucinations are one of the symptoms of hyperactive delirium
- Patients with delirium are at a greater risk of longer periods of hospitalisation, functional decline, increased need for long term care and short term mortality.
- There are no clear methods to treat delirium and the most effective strategy is the treatment of the underlying cause.
Can the following presentations be caused by stroke, delirium, or either?
Stroke
Right visual field loss
Loss of one side of the visual field (hemianopia) is related to stroke and unlikely to be caused by delirium.
Loss of attention to left side
Delirium is does not usually cause inattention to one side.
Either stroke or delirium
Disoriented to time
Disorientation to time, place or person can be caused by stroke or delirium.
Exaggerated responses to normal stimulation
Impulsivity may be caused by a stroke while delirium can cause altered consciousness (hypervigilance).
Disorganised speech
Both delirium and stroke can cause disorganised thought resulting in disorganised speech.
Easily distracted
Both delirium and stroke can cause impaired attention.
Visual hallucinations
Hallucinations can be caused by delirium and, more rarely, by stroke.
Sleep disturbance
Delirium and strokes can both be a cause of disturbed sleep.
As you can see, most of the statements can relate to either stroke or delirium so we must remain open as to which is the cause.
Page last reviewed: 29 Jul 2021
