Differential Diagnosis for Delirium

The following conditions can present with delirium and should be considered in the differential diagnosis:

• Single Most Likely Diagnosis

  • Dementia: Given the patient's age and presentation with the 3 Ws (wet, wacky, and wobbly), dementia is a likely underlying cause of delirium.
  • Hydrocephalus (e.g., normal pressure hydrocephalus): As described, hydrocephalus can cause delirium, especially in older adults with the characteristic triad of symptoms.

• Other Likely Diagnoses

  • Hypertensive Encephalopathy: This condition can cause delirium, especially if the patient has a history of hypertension and presents with severely elevated blood pressure.
  • Chronic Subdural Hematoma: This condition is common in older adults and can cause delirium, especially if there is a history of trauma or falls.
  • Herpes Encephalitis: Although less common, herpes encephalitis can cause delirium and should be considered, especially if the patient has a history of herpes simplex virus infection.

• Do Not Miss Diagnoses

  • Osmotic Demyelination Syndrome: This rare condition can cause delirium and has a high mortality rate if left untreated. It is often associated with rapid correction of hyponatremia.
  • Septic Encephalopathy: This condition can cause delirium and is often associated with systemic infections. It is crucial to identify and treat the underlying infection promptly.

• Rare Diagnoses

  • Prion Diseases (e.g., Creutzfeldt-Jakob Disease): These rare conditions can cause delirium and dementia, but are often difficult to diagnose.
  • Hashimoto's Encephalopathy: This rare condition is associated with autoimmune thyroiditis and can cause delirium, but is often responsive to corticosteroid treatment.

Justification for each category:

• Single Most Likely Diagnosis: Conditions that are most likely to cause delirium in the given context, based on the patient's age and presentation.
• Other Likely Diagnoses: Conditions that are common causes of delirium and should be considered in the differential diagnosis.
• Do Not Miss Diagnoses: Conditions that may not be the most likely cause of delirium but have a high potential for morbidity or mortality if missed.
• Rare Diagnoses: Conditions that are less common causes of delirium but should still be considered in the differential diagnosis, especially if other conditions have been ruled out.