Delirium Without Focal Signs Related to a Thalamic Stroke

This document reported a case of an 86-year-old man who presented with delirium as the sole symptom of a thalamic intraparenchymal hemorrhage. Despite having no focal neurological signs, a CT scan revealed a 1.8-cm hemorrhage, likely hypertensive in nature. The patient's delirium initially attributed to infections did not improve until the hemorrhage was managed. Although delirium can persist post-resolution of its cause, the thalamic hemorrhage was considered the primary contributor. The case highlighted that stroke can present solely with delirium, especially in older patients, and should be considered in differential diagnoses even without focal signs. The development of delirium post-stroke indicated a poor prognosis, including worse functional outcomes and higher mortality.