A Cute Brain Syndrome in the Medical Wards of Muhimbili Medical Centre, Dar es Salaam

Abstract

Acute psychiatric symptoms may be associated with a wide variety of physical illnesses (acute brain syndrome). These symptoms may arise as a result of direct involvement of the brain as in meningitis or cerebral malaria, or they may arise as a result of altered brain function associated with diseases primarily involving systems otier than the central nervous system, such as lungs and kidneys. It is important that doctors recognise those psychiatric symptoms which may indicate underlying physical disease since failure to do so may lead to the patient's death. This study was undertaken to identify the causes, clinical presentation and prognOSis of the acute brain syndorome in genral medical practice in Dar es Salaam, since there have been no previous studies on this topic in Tanzania. During a six week period from July 13 until August 31 1981, 21 patients were admitted to the medical wards of Muhimbili Medical Centre with evidence of acute brain syndorome, either before or at the time of admissiono The mean age of the patients was 2509 years (range 8 - 48 years). The male: female sex ratio was 1.3&1. Malria was the disease most commonly associated with acute psychiatric symptoms in the present study, (14 (66.06%) patients)o Five (23.8% of the 14 patients had other diseases such as anaemia, uraemia, hypertension, hepatitis and epilepsy_

In the remaining 7 patients the disease associated with the acute bralll synd~ome were: chronic renal failure (2 patients), meningitis (1 patient), meningoencephalitis (1 patient), subdural haematoma (1 patient), rickettsial disease (1 patient) and anaemia (1 patient). Fourteen (66.07%) patients had clouded consciousness on admission and 7 (33.03%) patients were either semiconscious or unconscious by the time of their admissiono Of the 14 patients with clouded consciousness 10 (47.6%) had agitated delirium and 4 (1901%) had quiet delirium. Of the 7 patients who were semiconscious or unconscious at the time of admission 4 (19f~ had agitated delirium and 3 (14.3%) had quiet delirium during the recovery phase. Thought disturbances were observed in 14 (6607%) patients and speech disturbances in 16 (76.2%) patientso All patients at sometime during the course of their illness showed evidence of disturbance in orientation, insight, memory and intelligences The mean duration of symptoms prior to admission was 3.8 days (range 1 - 14 days)o The main factor leading to delay in reporting to hospital was the belief by relatives that the patients problems were related to supernatural causes. Delay was also related to the patient1s age, the older the patient the longer the delay in referral. Duration of stay in hospital was also longer in older patients and in those who had other diseases apart from those which were

responsible for admission. There was also a relationship between duration of stay in hospital and the severity of psychiatric symptoms.

Seventeen (81%) of the 21 patients recovered but 3 patients required later referral to the Psychiatric Unit. Four (195/) patients died; one from cerebral malaria, two

from uraemia and one as a result of subdural haema toma, The diagnosis of subdural haematoma was made at post-mortem. !This patientts history highlights the need for all medical practitioners faced with a patient with acute psychiatric symptoms, to make every effort to exclude underlying physical illness.