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Delirium with urinary retention and constipation — SCE Geriatric Medicine MCQ

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ModerateDeliriumDelirium with urinary retention and constipationSCE Geriatric Medicine

An 86-year-old woman with severe frailty and heart failure is admitted with delirium. Her daughter asks for a brain MRI because CT shows cerebral atrophy. Examination shows inattention, fluctuating drowsiness, urinary retention and constipation; there are no focal neurological signs. What is the most appropriate management?

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Correct answer: A — Treat delirium precipitants and avoid further neuroimaging unless new focal signs or another indication develops

The clinical syndrome is delirium with clear reversible precipitants and no focal neurology. CT atrophy is common and does not require MRI for acute delirium unless there are features suggesting stroke, mass, encephalitis or trauma. Dementia medicines do not treat delirium. The pearl is that over-investigation can delay simple high-yield interventions such as bladder, bowel, pain and medication review.

Reference: NICE CG103; NICE NG97