COMA AND CHANGES IN MENTAL STATUS

Click here for Glasgow Coma Scale

"AEIOU TIPS"--diff. dx for coma

1. Alcohol-related
2. Encephalopathy
3. Insulin (hypoglycemia, hyperglycemia too)
4. Opiates
5. Uremia
6. Trauma
7. Infection
8. Psychiatric
9. Syncope

Causes of stupor/coma in series of 500 pts with initial dx of "Coma of unknown etiology":

1. Supratentorial lesions101

• IC hemorrh 44
• Subdural hemorr 26
• Cerebral infarction 9

2. Subtentorial lesions 65

• Brainstem infarct 40
• Compressive lesion 11

3. Diffuse/metabolic brain dysfn326

• Drugs 149
• Hepatic enceph. 17
• Encephalitis 14
• Endocrine, inc. DM 12

4. Psychiatric "coma" 8

n.b. 1 & 2 should give focal Px findings

(Plumb & Posner, Stupor and Coma)

Decorticate posturing = arms flexed, feet extended & sl. internally rotated

Decerebrate posturing = arms, feet extended & ext. rotated

Management of coma with uncertain dx:

• Give glucose, Thiamine, Narcan
• Send Chem20, Tox screen, LP if febrile (but check PT/PTT & platelets first!)