Coma final

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Approach to diagnosis of coma

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  • E.S.: 17yo female involved in car crash where she was ejected. Eyes remained closed in ER even after noxious stimulation was applied. There were occasional guttural vocalizations but no intelligible verbalizations. Decerebrate posture was apparent in both upper extremities and no evidence of active movement. Did not track objects presented directly in front of her when her eyelids were opened manually. CT scan showed small hemorrhages within the rostral midbrain, cingulate and collosal regions suggesting diffuse axonal injury.
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