A. Melka et al., ETIOLOGY AND OUTCOME OF NONTRAUMATIC ALTERED STATES OF CONSCIOUSNESS IN NORTH-WESTERN ETHIOPIA, East African medical journal, 74(1), 1997, pp. 49-53
Awareness of the relative prevalence of diseases causing altered state
s of consciousness (ASC) in a particular geographic locality could gre
atly facilitate the approach to patient management. This prospective s
tudy has, therefore, evaluated 202 patients with ASC admitted to the m
edical wards of GCMS teaching hospital in a two year period, between J
anuary 1994 and December 1995. ASC was defined as a clinical state man
ifested by conditions ranging from confusion and disorientation in per
son, place and time to stupor and deep coma. History, physical examina
tion, limited laboratory tests and course of the patient in the hospit
al were used to identify the aetiology. There were 122 (60.4%) males a
nd 80 (39.6%) females with male to female ratio of 3:2. Most of the pa
tients, 122 (60.4%), belong to the age group below 40 years and the me
dian age was 33 years (range = 15-84). The median duration of hospital
stay was six days (range = 1-90). The commonest cause was infections,
111 (55%) followed by metabolic disorders, 45 (22.3%), structural les
ions, 30 (14.9%) and poisoning, seven (3.5%). The aetiology was not id
entified in nine (4.5%) of the patients. Cerebral malaria was the comm
onest infectious cause followed by chronic meningitis and/or encephali
tis. In hospital mortality rate was 60.4%. Unknown diagnosis, structur
al neurologic and metabolic causes were associated with increased mort
ality rate, with p values of 0.002, 0.009 and 0.015, respectively. The
same was true for presence of HIV infection, P = 0.02. Since infectio
us causes are the commonest causes in our series, of which most are tr
eatable with a relatively favourable outcome, critical evaluation for
infections and early intervention is recommended. In addition, diagnos
tic facilities, especially for structural central nervous system lesio
ns has to be improved because successful treatment and prognosis depen
ds on the identification of a specific aetiology.