Aged individuals often present to the ED with acute neurologic syndromes. The disorders described in this article are among the most difficult to diagnose in the older patient. Accurate diagnosis of syndromes such as delirium or syncope mandates a thorough history and physical examination, even in the most frail or combative of patients. Treatment should be guided by the cause, and the reflex prescription of psychotropics avoided. The diagnosis of spinal cord compression in an older patient requires awareness of typical signs and symptoms as well as performance of a careful neurologic examination. This neurologic emergency demands prompt and aggressive treatment, with immediate neurologic or neurosurgical consultation.
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