Pertinent Historical Information

1. Is there a history of witnessed or suspected trauma?

2. Does patient have fever?

3. What is the probability of poisoning, ingestion, or overdose?

4. What are the associated symptoms (eg, headache, seizures, diplopia, weakness, vomiting, bloody diarrhea)?

5. Is there a contributing past medical history (eg, seizure disorder, brain tumor, ventricular shunt, sickle cell disease, metabolic disorder, diabetes, liver disease, renal failure)?

III. Differential Diagnosis. Etiologies of coma may be divided into structural or medical causes (Table I-9) and are similar to those for altered mental status, discussed in Chapter 6 (see pp. 27-31).

A. Structural Causes. Tend to result in asymmetric or focal neurologic findings, particularly affecting pupillary response, extraocular

TABLE I-9. COMMON DIAGNOSES OF COMA BY AGE

Infant

Child

Adolescent

Abuse Inborn error Infection Metabolic Seizure

Abuse/Trauma infection Seizure Toxin

Seizure

Toxin

Trauma

Psychiatric movements, and motor response to pain. (For additional discussion of these causes, see Chapter 6, Altered Mental Status, III, A, 1-4, p. 27.)

1. Trauma (eg, from shearing forces). When mechanism of injury does not fit the extent of child's injuries, always consider inflicted trauma or child abuse.

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