A very brief, bare-bones overview of neurological examination of a comatose patient. Tailored for BDS students.

1. UNCONSCIOUS?
What to look for

2. CONSCIOUSNESS
• Arousal-
• Level of alertness
• Deep brainstem and medial thalamus
• Ascending reticular activating system (RAS)
• Cognition-
• Level of awareness and coherence
• Cerebral cortex and major subcortical nuclei

3. COMA – WHAT IS IT?
• A state of complete loss of consciousness from which the
patient cannot be aroused by ordinary stimuli
• Quantification difficult
• Glasgow coma scale

4. GLASGOW COMA SCALE

5. ASK FOR…….
• Sequence of events-
• Relatives
• Co-habitants
• First responders
• Witnesses
• Past history
• Current medications

6. WHAT TO DO FIRST
• Safe position – neck
• Airway
• Breathing
• Circulation

7. GENERALLY SPEAKING……..
• Evidence of injury
• Vitals-
• PR, BP, Respiration, Temperature
• Posture
• Movements-
• Spontaneous
• Response to stimuli
• Appearance, Grooming
• Signs of chronic disease
• Neurologic examination
• Blood sugar value

8. NEUROLOGICALLY SPEAKING…..
• Pupils
• Breathing
• Motor response
• Sensory response
• Reflexes
• Meningeal signs

9. PUPILS
• Size
• Shape
• Position
• Equality
• Reactivity
• Reflexes-
• Oculocephalic
• Vestibulocephalic

10. BREATHING
• Pattern-
• Frequency
• Depth
• Involvement of respiratory centers
• Metabolic

11. MOTOR RESPONSE
• Face is an important area!
• Presence of movement
• Asymmetry
• Abnormal movement
• Unprovoked movements
• Tone
• Dropping the limb

12. POSTURE

13. SENSORY
• Stimuli to both sides to be checked
• Asymmetry noted
• All modalities-
• Touch
• Pain
• Temperature

14. REFLEXES
• Corneal
• Conjunctival
• Tendon
• Plantar
• Primitive

15. MENINGEAL SIGNS
• Neck stiffness
• Kernig’s
• Brudzinski’s

16. WHAT IS IT ALL FOR?!