An 85-year-old man with acute-onset of confusion and dyspnea after a fall: a diagnostic challenge

An 85-year-old patient, previously in good general condition and with no relevant clinical history, presented to the emergency department (ED) because of rapidly worsening confusion and dyspnea that had suddenly manifested 1 h after a fall. The fall was reported by the patient as accidental, due to stumbling against a chair. The patient could remember the fall, and did not report any loss of consciousness. Patient’s relatives confirmed the dynamics of the fall. They decided to call for emergency help when acute dyspnea and confusion appeared. Upon arrival, the patient appeared dyspneic, dysarthric and severely confused, with right-side deviation of a buccal grimace. The right leg was shortened and externally rotated. Hypotension, tachycardia, tachypnea and peripheral oxygen desaturation were present (Table 1). Differential diagnosis