Coma And Impaired Conscious Level

DIAGNOSTIC APPROACH (contd)

General examination (contd)

Hypotension/blood loss. Cardiac arrhythmias — Valvular disease-

Respiratory insufficiency Smell of alcohol-

Reduced cardiac output-

Emboli-

Anoxia -

Needle marks on limbs 'Snout' rash-

POSSIBLE CAUSE OF COMA/ IMPAIRED CONSCIOUS LEVEL

: Cerebral ischaemia

Alcohol abuse Drug abuse Solvent abuse

Neurological examination

Signs of raised intracranial pressure (I CP)

- papilledema 1

- tense anterior fontanelle > -

(in infants) J Neurological signs

- unilateral, dilated, fixed pupil

- bilateral dilated, fixed pupils

- pinpoint pupils

- eye movements absent (spontaneous or reflex)

- eye movements absent (spontaneous or reflex)

- asymmetric limb response (i.e. hemi/monoparesis)

pupils fixed pupils usually reacting —

Intracranial mass lesion Hydrocephalus

Diffuse cerebral swelling, e.g. anoxia

Drugs - anticholinergics 1 .

, . . > overdose sympathomimetics J

Drug - opiates parasympathomimetics Pontine haemorrhage Severe - trauma

— haemorrhage k Drugs (transient effect) Hypoxic I hepatic encephalopathy Focal brain damage, e.g.

— encephalitis

N.B. - hepatic encephalopathy " — hypoclycaemia

- uraemia

- Symmetrical limb responses

- Reacting pupils

- Full eye movements occasionally produce asymmetrical responses suggest a metabolic encephalopathy or drug toxicity

- Subhyaloid/vitreous haemorrhage (on fundoscopy)

Subarachnoid haemorrhage

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