Cranial Computed Tomography Study of Patients with Acute Confusional States
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Abstract
Objectives: To study the neurn-imaging findings in patients with acute confusional (AC) states with a view of diagnosing the organic conditions that cause AC.
Setting: Radiology Department of a University Teaching Hospital.
Method: Retrospective analysis of brain computed tomography (CT) films, radiology and medical records of patients who underwent CT scans on account of AC. The study of brain CT scans were conducted over a three-year- period (from 1" March 2001 to 28 February 2003).
Result: Twenty five patients, (12 males and 13 females) who were referred to the CT scan unit of a University Teaching Hospital had their CT scan findings and presenting symptoms studied. The patients' age range was from 40 to 69 years, with the 65 to 69 years having the highest frequency of 7 (28%) and the mean age was 63+/-6 years. All the patients presented with acute confusional (AC) states. In addition to AC states, other symptoms or presenting history were hallucination observed in 9 patients (36%), stroke in evolution seen in 5 patients (20%), coexisting diabetes and hypertension 4 patients (16%), electrolyte imbalance in 3 patients (12%), drug ingestion/intoxication 2 (8%), vomiting and neck pain 1 (4%) while 1 (4%) patient presented with history of steroid therapy. In the CT scan findings, 22 patients (88%) had abnormal while 3 patients (12%) had normal findings. The commonest findings were multiple areas of acute cerebral infarction with focal areas of post infarction atrophy in 610 (40%) patients, acute intracerebral haemorrhage with areas of previous focal chronic infarction in 5 (20%), acute intracerebral haemorrhage in 3(12%), and subacute large thrombotic unihemispheric infarct in 2 (8%) patients. There were acute intraventricular haemorrhage in 1(4%) patient and generalised cerebral atrophy in 1 (4%) patient.
Conclusion: CT scan can help in early diagnosis of the organic and treatable conditions that cause AC states instead of grouping all the diagnoses together as chronic progressive dementias. From the result, 88% of the patients had organic intra-cerebral lesions causing AC and many of them are treatable and preventable Where they are available and when the patients can afford them in developing countries, neuro-imaging studies are advised in elderly patients with AC states for early diagnosis of treatable conditions that cause AC states.
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