ACUTE CONFUSIONAL STATE

ETIOLOGICAL SPECTRUM

Abstract

Objectives: The study was planned to work out the important
organic causes of Acute Confusional State (ACS) in our population, so as to help in pointing out important and
common causes of ACS in our setup thus helping to keep in mind different diseases while we are confronted
with a patient of ACS. Study Design: A descriptive study was conducted at Military Hospital Rawalpindi to
evaluate patients admitted with a provisional diagnosis of acute confusional state. One hundred adult patients
were consecutively included in the study. Place and Duration: The study was conducted at Military Hospital,
Rawalpindi. It spanned over the period of 07 months from Oct 2000 to Apr 2001. Subject/Methods: One
hundred adult patients of both genders admitted with a provisional diagnosis of ACS, presenting within 48 hours of the
onset of symptoms were consecutively included in the study. Patients were assessed on Diagnostic and Statistical Manual,
4 Edition (DSM-IV) classification of American Psychiatric Association (APA) th and level of consciousness was assessed
according to Glasgow Coma Scale. Detailed neurological and systemic examination was done. All the relevant investigations
were done immediately including biochemical profile, Blood CP, Urine RE, ECG and Chest X-Ray Other important
investigations like lumbar puncture, CT scan head and MRI etc were done where indicated. Results: The study showed that
neurological lesions and metabolic encephalopathies accounted for about 70% of the cases followed by infections (10%)
and drugs/toxins (8%) Amongst the neurological diseases stroke is the most common while in metabolic encephalopathies,
hepatic encephalopathy is the commonest followed by ureaemic encephalopathy. Conclusion: The study has highlighted
the epidemiology of the organic causes of ACS encountered in the patients of the Military Hospital, Rawalpindi, helping
us to conclude that neurological and metabolic disorders are the most common organic cause of ACS.