Clinical and investigational study for the aetiological evaluation of patients in nontraumatic altered sensorium and its outcome

Siba Narayan Jali, Sachida Nanda Nayak, Biju K. Alexander, Diptimayee Tripathy, Bijaya K. Behera


Background: Apart from head injury many patients present to the tertiary care hospital in unconscious state, the etiology of which is obscure in most of the cases. The present study was conducted with on objective to provide insight into the clinical features and diagnostic methods to know the aetiology of patients with non-traumatic cases of altered sensorium and to study the outcome of these patients.

Methods: This is an observational study on 100 patients of altered sensorium of non-traumatic origin during the period from October 2012 to September 2014 conducted in the Department of General Medicine, MKCG Medical College Hospital, Berhampur, Odisha, India. All patients were selected for the study based on the inclusion exclusion criteria. Detailed history, clinical evaluation, laboratory investigations like neuroimaging studies etc. were carried out. Statistical data analysis was done using Graph pad Prism 6 and Microsoft Excel. P value <0.0001 was considered statistically extremely significant.

Results: Out of 100 patients of altered sensorium, 64 were males and 36 were females. All patients were in the age group of 19 to 89 years. Cerebrovascular accident was the most common aetiology of altered sensorium followed by metabolic encephalopathy and infection. Altered sensorium in patients with CVA carries a high mortality. Metabolic causes and younger age indicated a better prognosis, patients with low (Glasgow Coma Score) GCS score of 3 to 4 had poorer prognosis.

Conclusions: The results suggest that clinical assessments yield accurate predictive information about the potential for recovery in cases of altered sensorium. So, this study concludes that empirically based estimates of prognosis in the neurologically severely ill provides great reassurance to those involved in a decision-making process, including patients’ families and physicians.


Altered sensorium, Brain stem reflexes, Glasgow coma score, Neuro ophthalmic signs

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Allan H. Ropper. Coma. In. Harrison’s principles of Internal Medicine, 18th ed. USA, Mc Graw-Hill Education. 2012;2(274):2247-52.

Disorders of function in the light of anatomy and Physiology. In: John Walter eds. Brain’s diseases of the nervous system 12th ed. New York; Oxford University Press. 2009:950-953.

Khosroshahi N, Alizadeh P, Khosravi M, Salamati P, Kamrani K. Spinal fluid lactate dehydrogenase level differentiates between structural and metabolic etiologies of altered mental status in children. Iranian J Child Neurol. 2015;9(1):31.

Porth C. Essentials of Pathophysiology: concepts of altered health states. Lippincott Williams and Wilkins; 2011.

Plum and Posner. Prognosis in Coma. In: Plum F, Posner D. Diagnosis of Stupor and Coma. 3rd ed. Philadelphia; FA Davis Company; 1982:329-45.

Disorders of function in the light of Anatomy and Physiology. In: John Walter eds. Brain’s diseases of the nervous system. 12th Ed. New York; Oxford University Press. 2009:950-953.

Jennett B, Bond M. Assessment of outcome after severe brain damage:a practical scale. Lancet. 1975;305(7905):480-4.

Srinivasan K. Study of unconscious patients. NSI. 1982:72-76.

Cartia AB. Cerebral Infarction. In: Caster AB. Stroke in Young. 2nd ed. New York; Mcmillan Company: 1964:236-42.

Cooper ES, IPSEN J, Brown HD. Determining factors in the prognosis of stroke. Geriat. 1963;18:3.

Jones HJ, Millikan CH. Temporal profile (clinical course) of acute carotid system cerebral infarction. Stroke. 1976;7(1):64-71.

Oxbury JM, Greenhall RC, Grainger KM. Predicting outcome of stroke; Acute stage after cerebral infarction. BMJ. 1975;3:125-27.

Richardson, Tumphy, McKissock J. Subarachnoid haemorrhage, its Mortality and Outcome. Stroke. 1977;3:122-26.

Sacco RL, VanGool R, Mohr JP, Hauser WA. Nontraumatic coma: Glasgow coma score and coma etiology as predictors of 2-week outcome. Archives Neurol. 1990;47(11):1181-4.

Hamel MB, Goldman L, Teno J, Lynn J, Davis RB, Harrell FE, et al. Identification of comatose patients at high risk for death or severe disability. JAMA. 1995;273(23):1842-8.

John G. Non traumatic Coma. JAPI. 1997;45(2):904.

Plum F, Caronna JJ. Can one predict outcome of medical coma? In outcome of severe damage to the central nervous system. Elsevier-NorthHolland, Amsterdam. 1975:121-39.

Levy DE, Bates D, Caronna JJ, Cartlidge NE, Knill-jones RP, Lapinski RH, et al. Prognosis in nontraumatic coma. Annals Internal Med. 1981;94(3):293-301.