States of impaired consciousness

Structural basis for Coma

Causes of Coma

Distinguishing between structural or metabolic/toxic causes of coma

Toxic/metabolic Coma

Structural Lesions Causing Coma

Diffuse, multifocal deficits

Signs point to a single locus (focal findings)

Signs can fluctuate

May deteriorate in a rostralÞ caudal progression

Oculo-vestibular responses may be lost

Eye movements are comprimised with brainstem injury

Pupil response to light is usually preserved

Pupil responses can be impaired with brainstem injury

Treat with support and correction of metabolic disorder

May require neurosurgical decompression

Initial management of the comatose patient

Clinical Features