This chapter, written for undergraduate medical students and post-graduate doctors in training, presents information on how to manage acute confusion — a case which they are likely to encounter in the future in a general practice setting. It presents the case of a 60-year-old woman who reports that she woke the previous night to go to the toilet, felt confused, lost her way and fell in the kitchen. She thinks that she momentarily lost consciousness, but managed to crawl to the toilet and get back into bed. The chapter provides details of the patients' medical history and the key findings of clinical examination, together with initial investigation results data for evaluation, and helps them develop their skills of clinical reasoning. Key questions then prompt the student to evaluate the patient, and reach a decision regarding their condition and the possible treatment plan.