Fundal examination

The presence of papilloedema or fundal haemorrhage or emboli, together with the findings of hypertensive vascular or

Table 1.1 Neurological assessment of coma



Glasgow Coma Scale

Eye opening

Motor response

Verbal response

Brain stem function

Pupillary reactions

Corneal responses

Spontaneous eye movements

Oculocephalic responses

Oculovestibular responses

Respiratory pattern

Motor function

Motor response

Muscle tone

Tendon reflexes


diabetic retinopathy, is important. The fundal appearances may be diagnostic as in subhyaloid haemorrhage but more commonly only help to confirm or refute evidence of raised intracranial pressure. The absence of papilloedema does not necessarily mean that there is no raised intracranial pressure.

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