We discuss the case of an 83-year-old man admitted to the hospital after losing control of his vehicle due to an unexplained episode of altered consciousness. This occurred on a background of multiple similar episodes associated with acute confusion, superimposed on a gradual cognitive decline spanning 6 years. Organic aetiologies for delirium were excluded and CT and MRI of the brain were negative for cerebrovascular accidents or other epileptogenic foci. Electroencephalogram (EEG) was negative for epileptiform activity. A diagnosis of seizure in the setting of dementia with Lewy bodies (DLB) was deemed probable. Subsequent brain single-photon emission computed tomography (SPECT) and flurodeoxy glucose-positron emission tomography (FDG-PET) studies supported the underlying diagnosis of DLB. Acute changes in consciousness or cognition are often related to strokes or seizures in the older person. As illustrated in this case, however, it is important to consider alternative comorbidities that may coexist.
- geriatric medicine
- epilepsy and seizures
- memory disorders (psychiatry)
- dementia, alzheimer’s type
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Handling editor Seema Biswas
Contributors MZT, first author, performed substantial contribution to the conception, design and drafting to the work, analysis and interpretation of date. Authors RK, W-KS and KW contributed largely in revising critically important intellectual contents multiple times. Agreement to be accountable for all aspects of the work was obtained. Final approval of the version was done by MZT and RK.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.