ETIOLOGY AND OUTCOME OF NONTRAUMATIC ALTERED STATES OF CONSCIOUSNESS IN NORTH-WESTERN ETHIOPIA

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.