Aetiologies of altered states of consciousness: A prospective hospital-based study in a series of 464 patients of northern Tanzania

Winkler, Andrea Sylvia; Tluway, Anthony; Schmutzhard, Erich

doi:10.1016/j.jns.2010.10.004

Cited by 8 publications

(7 citation statements)

References 11 publications

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“…These observations are important for medical faculties that have to adequately prepare general practitioners and nurses for the complex management of neurological disorders in remote African areas. In our cohort, altered consciousness was less frequent than in the largest prospective series to date in North Tanzania, 22 where this syndrome was the cause for more than half of the neurological admissions. The difference is likely explained by the exclusion of post-traumatic pathology in our study, the low prevalence of HIV infection in our cohort (although it was not tested in the Tanzanian study), and by the more general criteria of inclusion we used to capture a maximum of neurological disorders since their earliest stages.…”

Section: Discussioncontrasting

confidence: 64%

“…About 20% of the patients with neurological disorders suffered from CNS infections that were robustly confirmed by a panel of reference tests. Previous studies provided contradictory results and reported either lower or higher prevalence estimates of infections that likely depended on different periods, 5 , 6 settings, 8 inclusion criteria, 22 or diagnostic tests. 9 , 10 Bacterial meningitis, largely preventable by vaccination, and unspecified meningoencephalitis accounted for up to 10% of the total case load, even in the older population of our study.…”

Section: Discussionmentioning

confidence: 98%

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Clinical Spectrum, Etiology, and Outcome of Neurological Disorders in the Rural Hospital of Mosango, the Democratic Republic of Congo

Mukendi

Kalo

Mpanya

et al. 2017

The American Journal of Tropical Medicine and Hygiene

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Abstract.There is little published information on the epidemiology of neurological disorders in rural Central Africa, although the burden is considered to be substantial. This study aimed to investigate the pattern, etiology, and outcome of neurological disorders in children > 5 years and adults admitted to the rural hospital of Mosango, province of Kwilu, Democratic Republic of Congo, with a focus on severe and treatable infections of the central nervous system (CNS). From September 2012 to January 2015, 351 consecutive patients hospitalized for recent and/or ongoing neurological disorder were prospectively evaluated by a neurologist, subjected to a set of reference diagnostic tests in blood or cerebrospinal fluid, and followed-up for 3–6 months after discharge. No neuroimaging was available. Severe headache (199, 56.7%), gait/walking disorders (97, 27.6%), epileptic seizure (87, 24.8%), and focal neurological deficit (86, 24.5%) were the predominant presentations, often in combination. Infections of the CNS were documented in 63 (17.9%) patients and mainly included bacterial meningitis and unspecified meningoencephalitis (33, 9.4%), second-stage human African trypanosomiasis (10, 2.8%), and human immunodeficiency virus (HIV)-related neurological disorders (10, 2.8%). Other focal/systemic infections with neurological manifestations were diagnosed in an additional 60 (17.1%) cases. The leading noncommunicable conditions were epilepsy (61, 17.3%), psychiatric disorders (56, 16.0%), and cerebrovascular accident (23, 6.6%). Overall fatality rate was 8.2% (29/351), but up to 23.8% for CNS infections. Sequelae were observed in 76 (21.6%) patients. Clinical presentations and etiologies of neurological disorders were very diverse in this rural Central African setting and caused considerable mortality and morbidity.

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Section: Discussioncontrasting

confidence: 64%

Section: Discussionmentioning

confidence: 98%

Clinical Spectrum, Etiology, and Outcome of Neurological Disorders in the Rural Hospital of Mosango, the Democratic Republic of Congo

Mukendi

Kalo

Mpanya

et al. 2017

The American Journal of Tropical Medicine and Hygiene

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“…11 Regarding infective cause, our series was similar to Ziaul Huq s series where pyogenic cause was the commonest (52.6% vs 50%). 7 Regarding poisoning the common cause was unknown poisoning whereas in other series insecticide poisoning was common in other parts of our country.…”

Section: Discussionsupporting

confidence: 82%

Aetiology and Short-term Outcome of Altered Level of Consciousness among Patients in Medicine Department of a Tertiary Hospital

et al. 2017

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Background: Altered level of consciousness is a very common medical emergency resulting in considerable mortality & morbidity. Accurate diagnosis & prompt management can reduce the complications to a great extent. There are various aetiologies of impaired consciousness including infective & metabolic causes as well as cerebrovascular accidents. This study described clinical outcomes of the patients relating to specific aetiologies of the illness.Objectives: To explore the common aetiologies of altered consciousness & to determine the clinical outcomes of the patients after one month in a tertiary level hospital of Bangladesh.Methods: This hospital based prospective observational study was conducted in Medicine department of Dhaka Medical College Hospital (DMCH) from December 2013 to May 2014. Sample size was 100 & the data was collected by structured questionnaire. Purposive sampling method was applied using inclusion & exclusion criteria. Statistical analysis of the result was obtained by using SPSS-16.Results: The mean age of the study patients was found 48.7 years with range from 19-92 years. Majority (58%) of the patients were male. Stroke was identified as the commonest (39%) aetiology of impaired consciousness followed by meningo-encephalitis (19%), septicemia (10%) & poisoning (10%). Among metabolic encephalopathy diabetic ketoacidosis was 3%, hypoglycemia 1% and hepatic, uremic & hypertensive encephalopathy was 3%, 4% & 1% respectively. Overall death rate was higher among patients with stroke (26%), ICSOL (50%), ADEM (50%) than those with meningoencephalitis (5.3%), septicemia (20%) & poisoning (10%).Conclusion: Infective & metabolic causes of impaired consciousness showed better outcome than structural & vascular aetiologies of brain.J MEDICINE July 2017; 18 (2) : 80-85

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“…The reported prevalence of dementia for hospital-based studies ranged from 0.05% at a neuropsychiatric practice in southwestern Nigeria (survey period 1998–2007) [45], to 8.87% at a geriatric center in Dakar, Senegal [51]. Further, dementia accounted for 6.90% of patients with acute confusional state in a hospital in Tanzania [48], while 74.00% of 305 patients who presented to a memory clinic in South Africa were diagnosed with dementia [53]. The incidence of dementia in SSA was only reported in two population-based studies both conducted in Nigeria-Yorubas.…”

Section: Resultsmentioning

confidence: 99%

“…The incidence of dementia in SSA was only reported in two population-based studies both conducted in Nigeria-Yorubas. The age-standardized annual incidence rate of dementia reported by one of the studies was 1.35% (AD = 1.15%) [48], while the other study reported a dementia incidence of 2.19% in a survey of 1225 Yoruba subjects, aged 65 years and above [24]. Major risk factors for dementia that were identified by most of the population-based studies included increasing age, female gender, cardiovascular disease, and low-literacy level [6, 10, 35].…”

Section: Resultsmentioning

confidence: 99%

Epidemiology of Dementia among the Elderly in Sub-Saharan Africa

Olayinka

Mbuyi

2014

International Journal of Alzheimer's Disease

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Objectives. To review epidemiologic studies on the prevalence, incidence, and risk factors of dementia in sub-Saharan Africa (SSA). Methods. A MEDLINE search (from January 1992 to December 31, 2013) of epidemiologic studies, with no language restriction, was conducted using the keywords “dementia” or “Alzheimer's” and “Africa.” We selected for review population and hospital-based studies that reported the prevalence, incidence, or risk factors of dementia in SSA in people aged 60 years and above. References of selected articles were reviewed to identify additional relevant articles that met our selection criteria. Results. Of a total of 522 articles, 41 were selected and reviewed. The reported prevalence of dementia in SSA varied widely (range: 2.29%–21.60%); Alzheimer's disease was the most prevalent type of dementia. Only two studies conducted in Nigeria reported incidence data. Major risk factors identified include older age, female gender, cardiovascular disease, and illiteracy. Conclusion. Data on the epidemiology of dementia in SSA is limited. While earlier studies reported a lower prevalence of dementia in older persons, recent studies have put these findings into question suggesting that dementia prevalence rates in SSA in fact parallel data from Western countries.

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Aetiologies of altered states of consciousness: A prospective hospital-based study in a series of 464 patients of northern Tanzania

Cited by 8 publications

References 11 publications

Clinical Spectrum, Etiology, and Outcome of Neurological Disorders in the Rural Hospital of Mosango, the Democratic Republic of Congo

Clinical Spectrum, Etiology, and Outcome of Neurological Disorders in the Rural Hospital of Mosango, the Democratic Republic of Congo

Aetiology and Short-term Outcome of Altered Level of Consciousness among Patients in Medicine Department of a Tertiary Hospital

Epidemiology of Dementia among the Elderly in Sub-Saharan Africa

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