title: Evaluating the comatose patient. Rapid neurologic assessment is key to appropriate management.
abstract: Coma is defined as a sleeplike state in which the patient is unresponsive to self and the environment. Coma should be distinguished from the persistent vegetative state and locked-in syndrome. It is important to obtain a carefully taken history from eyewitnesses and to perform a rapid neurologic examination focusing on pupillary responses, eye movements, and motor responses. Pupils reactive to light usually indicate metabolic or medical coma; cerebellar infarction or hemorrhage is a notable exception. A pupil unreactive to light often points to a structural brain lesion and the need for urgent neurosurgical consultation. The prognosis for coma depends on the cause.
authors.affiliation: Neurology Service, Veterans Affairs Medical Center, Augusta, Georgia, USA.
authors.forename: Khalid
authors.initials: K
authors.lastname: Malik
authors.forename: David C
authors.initials: DC
authors.lastname: Hess
mesh_terms: D003128:Coma / Q000145:classification / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D003937:Diagnosis, Differential; D005133:Eye Movements; D006801:Humans; D009043:Motor Activity; D009460:Neurologic Examination; D011320:Primary Health Care; D011379:Prognosis; D012025:Reflex, Pupillary; D012119:Respiration