A Case Report of an Acute Confusional State, in an Elderly Female Patient with Venous Thrombosis of the Leg

Delirium, also known as acute Confusional state, is a common presentation in geriatrics. It is characterized by an acute and a fluctuating disturbance of consciousness, and a deficit in cognitive functions. Delirium that occurs in demented people is referred to as delirium superimposed on dementia.
The patient presented here was a challenging case of an elderly female with 86 years of age that was diagnosed with delirium superimposed on dementia (DSD). The patient developed DSD in parallel with venous thrombosis (VT) affecting her right leg. Venous thrombosis was initially superficial, affecting the great saphenous vein (GSV), which later progressed to deep venous thrombosis (DVT). The therapeutic approach for this patient was literally a dilemma, and a distressing situation to the patient, medical and paramedical staff, and the caregivers. The patient refused feeding, and had refractory insomnia. Additionally, the patient became frequently hyperactive throughout the day in association with frequent delirium attacks. The hyperactivity was difficult to control, despite her leg condition (DVT) that required cautious immobilization to prevent the catastrophe of a superimposed episode(s) of thromboembolic phenomenon. Luckily, a pulmonary thromboembolism never happened.
The patient resisted, and sometimes completely rejected diagnostic or therapeutic intervention, and medical consultations. A multidisciplinary approach was mandatory, and the DSD was eventually successfully well-managed, with an adjusted dose of haloperidol, a high potency first generation antipsychotic drug. Subsequently, her medical and surgical complications were also successfully managed. Finally, the patient was discharged from the hospital, and later scheduled, for a reconstructive surgery, using autologous mesh skin grafting under regional anesthesia, to cure her refractory venous leg ulcer. The venous ulcer occurred as a complication for the venous thrombosis.