Because the comatose patient cannot understand and follow commands, the examination of the comatose patient is a modified version of the neurological examination of an alert patient. If a patient is comatose, it is safe to assume that the nervous system is being affected at the brainstem level or above. The goal of a neurological examination in a comatose patient is to determine if the coma is induced by a structural lesion or from a metabolic derangement, or possibly from both. Structural Lesion Two findings on exam strongly point to a structural lesion: 1.
Consistent asymmetry between right and left sided responses 2. Abnormal reflexes that point to specific areas within the brain stem. Mental status Mental status is evaluated by observing the patient's response to visual, auditory and noxious (i.e., painful) stimuli. Three main maneuvers to produce a noxious stimulus in a comatose…
