Delirium is a consequence either of a primary brain lesion or of cerebral involvement secondary to systemic illness, including those cases caused by exogenous substances such as drugs and poisons. A wide variety of causes act by way of a common pathway of neurochemical disturbance to produce the clinical syndrome.34

It is important to stress that in the elderly, delirium may be the sole presentation of a serious acute illness, such as myocardial infarction or sepsis.33 Almost any sufficiently severe acute medical or surgical condition may, under the right circumstances, cause the syndrome. Some of the more common causes of delirium are given in Box 4.3.

Although most cases of the clinical syndrome present little difficulty in determining a cause, a substantial minority of patients (as high as 5-20% of the elderly delirious)35 never receive an aetiological diagnosis. In this situation it may be necessary to reconsider the diagnosis, but cases remain where

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