Clinical-anatomical correlation in coma The neurologist has to determine: where is the lesion responsible for coma? what is its nature?
what is it doing? Bilateral hemisphere damage/dysfunction –symmetrical signs (tone and flexor or extensor response to pain) –may have fits or myoclonus –normal brain stem reflexes –normal oculocephalic response (OCR): normal caloric (fig 2 ) –normal pupils Supratentorial mass lesion with secondary brain stem compression –ipsilateral third nerve palsy –contralateral hemiplegia Brain stem lesion –early eye movement disorder: abnormal OCR or caloric –asymmetrical motor responses Toxic/metabolic –normal pupils: single most important criterion (except opiate poisoning) –ocular motility: rove randomly in mild coma and come to rest in primary position with deepening coma –absent OCR and caloric –decorticate and decerebrate rigidity or flaccidity –multi focal…
