AbstractDelirious mania is a clinical syndrome in which the signs and symptoms of delirium manifest themselves in the context of a manic episode. Though there have been numerous descriptions and case reports of this syndrome, all have described mania as the presenting feature, with signs of delirium developing subsequently, and none of the vignettes have involved elderly patients. We report two cases of elderly individuals with mania who initially presented as in a delirium. Both of them experienced clear manic episodes, which were confirmed by their psychiatric histories and clinical responses to mood stabilizers. Mania needs to be in the differential diagnosis of elderly people presenting with confusion, disorientation, and perceptual changes, particularly in those with a history of bipolar disorder. Copyright © 2001 John Wiley & Sons, Ltd.