Approach to Management of the Unconscious Patient

Jerome B. Posner, Clifford B. Saper, Nicholas D. Schiff and Fred Plum

in Plum and Posner's Diagnosis of Stupor and Coma

Fourth edition

Published on behalf of Oxford University Press

Published in print February 2008 | ISBN: 9780195321319
Published online April 2013 | e-ISBN: 9780199322954 | DOI:

Series: Contemporary Neurology Series

Approach to Management of the Unconscious Patient

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This chapter has presented a physiologic approach to the differential diagnosis and the emergency management of the stuporous and comatose patient. The approach is based on the belief that after a history and a general physical and neurologic examination, the informed physician can, with reasonable confidence, place the patient into one of four major groups of illnesses that cause coma. The specific group into which the patient is placed directs the rest of the diagnostic evaluation and treatment. At times, however, the diagnosis is uncertain even after the examination is completed, and it is necessary to defer even the preliminary categorization of patients until the imaging or metabolic tests are carried out and the most serious infections or metabolic abnormalities have been considered. If there is any suspicion of a mass lesion, immediate imaging is mandatory despite the absence of focal signs. Conversely, the presence of hemiplegia or other focal signs does not rule out metabolic disease, especially hypoglycemia. At all times during the diagnostic evaluation and treatment of a patient who is stuporous or comatose, the physician must ask him-or herself whether the diagnosis could possibly be wrong and whether he or she needs to seek consultation or undertake other diagnostic or therapeutic measures. Fortunately, with constant attention to the changing state of consciousness and a willingness to reconsider the situation minute by minute, few mistakes should be made.

Chapter.  12963 words.  Illustrated.

Subjects: Neurology

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