An Unexpected Cause of Hyperactive Delirium in Patients with Decompensated Nonalcoholic Cirrhosis

Delirium is a complex neuropsychiatric syndrome that typically involves a plethora of cognitive and non-cognitive symptoms, resulting in a broad spectrum of differential diagnosis dominated by mental disorders. The prevalence of delirium in elderly patients admitting to hospital is 5-55% [1]. Delirium is a common neuropsychiatric syndrome that may occur in several different settings and one of them is vitamin B12 deficiency. Vitamin B12 deficiency causes many cerebral cortex abnormalities such as confusion, mood and memory changes, delirium with or without hallucinations, depression and acute psychotic states [2,3]. Hepatic encephalopathy (HE) describes the spectrum of potentially reversible neuropsychiatric abnormalities seen in patients with liver dysfunction after exclusion of unrelated neurologic and/or metabolic abnormalities. The clinical manifestations of HE is characterized by cognitive and motor deficits of varying severity without specific lesions in the central nervous system. The symptoms range from minimal changes in personality to coma, including delirium [4]. Usually, in the elderly patients with cirrhosis, it is hard to differentiate two clinical situations. Here we report a case of an elderly patient with cirrhosis who experienced delirium due to vitamin B12 deficiency, but was treated as HE before.