You are asked to review a 65 year-old man who is comatose (GCS 3) with small pupils (2 mm bilaterally). He has a history of diabetes mellitus and bipolar disorder. He was discharged from hospital yesterday, following a surgical procedure.
4 more scenarios for Peter Gates Brainstem Rule of 4. Neurological lesion identification and neuro examination quiz
4 more scenarios for Peter Gates Brainstem Rule of 4. Neurological lesion identification and neuro examination quiz
Consider a 45 year-old HIV positive male with right hemiparesis and fluctuating conscious state. His CT head is shown below.
Coma-like Syndromes
ICU Acquired Weakness (ICUAW) includes critical illness myopathy (CIM); critical illness polyneuropathy (CIP), or a mixture of both (myopathy is typically predominant); very common in the mechanically ventilated (25-60% in those mechanically ventilated for > 7 days)
Wilhelm Heinrich Erb (1840-1921) was a German neurologist.
Nikolaus Friedreich (1825-1882) was a German neurologist and pathologist.
Pseudocoma is the term used for a patient feigning a comatose state, however it is sometimes also used for conditions like locked-in syndrome where patients may involuntarily appear unconscious but are actually self aware
Spinal cord syndromes
Status epilepticus: continuous seizure activity for 5 minutes or more without return of consciousness, or recurrent seizures (2 or more) without an intervening period of neurological recovery
Watershed infarcts result from severe hypotensive insults. They occur in areas with relatively poor blood supply at the boundaries between territories of cerebral arteries or their branches.