Although disturbance of consciousness in delirium patients have been well
established, but sudden drop of Glasgow Coma Scale (GCS) level to three is
frightening and mysterious. We are reporting a case of a delirious elderly
man with multiple medical illnesses presented with acute precipitous
decrement of GCS with pin point pupils bilaterally after given a course of
benzodiazepines and regained full consciousness spontaneously 32 hours
later. We discussed the use of deliriogenic medications in the context of
delirious elderly gentleman with multiple medical illnesses. We also looked
into the possible differentials of sudden drop of conscious level with bilateral
pin point pupils.