IATROGENIC STROKE AND UNDIAGNOSED DELIRIUM: OPPORTUNITIES TO IMPROVE CARE FOR HOSPITALIZED ELDERS. R. Sudore 1 , C. Landefeld 1 ; 1 University of California, San Francisco, San Francisco, CA (Tracking ID #73989) LEARNING OBJECTIVES: To describe the risk of stroke after cardiac catheterization and to recognize iatrogenic impediments to stroke rehabilitation in elderly patients. CASE INFORMATION: An independent 73 yr-old man with a history of NIDDM and HTN was transferred for cardiac catheterization (cath) after a recent non-Q-wave MI. An uneventful cath revealed 5 vessel disease and an ejection fraction of 30%. 90 minutes post cath he developed right hemiparesis and receptive and expressive aphasia. Head CT was negative and TPA was administered within 2 hours of symptom onset, but without clinical improvement. Two weeks later, neurologic function had not improved; agitation developed and hand restraints and diazepam were started. On consultation, we confirmed the sequelae of stroke, identified ischemic lesions in three toes, and diagnosed delirium. Serum sodium was 128, but other lab studies were normal. After discontinuing diazepam and restricting free water, his agitation resolved, and his dysphagia and receptive aphasia improved. Physical therapy was started. Once his restraints were discontinued his strength improved, though other than feeding, he remained dependent in all activities of daily living. IMPLICATIONS/DISCUSSION: This case highlights the importance of iatrogenic stroke and of undiagnosed delirium. Stroke occurs unpredictably in 0.1% of persons undergoing cath. Stroke is most often due to emboli, as evidenced by this man's cerebral and toe ischemia. His risk factors for stroke from cath included advanced age, extent of coronary artery disease, and depressed ejection fraction. In-hospital delirium incidence on medical wards varies from 11± 33%; the diagnosis is often missed in elderly patients. Delirium increases the risk of death 8fold and the frequency of nursing home placement 5-fold. Diazepam likely led to this man's delirium and slowed his rehabilitation. Also, restraints have been shown to exacerbate delirium, adding to deconditioning and slow recovery. In addition, the incidence of delirium is decreased from 15% to 10% by a multicomponent inter-vention including avoidance of benzodiazepines and restraints, but this intervention is not implemented in most hospitals, including ours. As more elders undergo cath, iatrogenic stroke may occur more often. Simple clinical strategies are indicated to prevent delirium, which is often missed and may slow or prevent rehabilitation from stroke.