One confused patient, many confused physicians: a case of delayed post-hypoxic leucoencephalopathy.
A 28-year-old gentleman was referred to our medical department from the psychiatry department, with problems of confusion, disorientation and inappropriate behaviour. He was apyrexic and physical examination was unremarkable. He denied hallucinations, delusions or mood disturbance and had no insight of his current problems. Mini-Mental State Examination (MMSE)1 score was 6/30.

Two years previously he started to use cocaine and heroin episodically. He consumed more than 40 units of alcohol each week.

Five weeks prior to his transfer, he had been admitted to another local hospital after an episode of heavy alcohol and drug consumption. His girlfriend had been unable to wake him up for a number of hours, and on arrival he was treated with naloxone, with a rapid improvement in level of consciousness.

Routine investigations were normal. A urinary toxicology screen was suggestive of recent ingestion of benzodiazepines, opiates and …