Unequal pupil size medical term11/15/2022 ![]() 1 Mathematical scales based on neurological findings have also been developed to define altered mentation. Patients in a light coma respond to noxious stimuli with a variety of protective reflexes, whereas patients in a deep coma do not respond to pain. The comatose patient cannot be aroused and a purposeful response cannot be provoked. Light reflex loss and anisocoria suggest a structural aetiology.Ĭoma can be defined as a state of unarousable unresponsiveness. Multivariate logistic regression analysis showed light reflex loss (likelihood ratio for positive test result 3.59) and anisocoria (likelihood ratio for positive test result 9.0) as independent predictors of structural origin.Ĭonclusions: In this prospective study of patients presenting to the emergency room of a community based teaching hospital with coma, in about 60% the coma is of metabolic origins and in about 40% of structural origins. Structural causes included intracerebral haemorrhage, subarachnoid haemorrhage, cerebral infarction, subdural haematoma, and epidural haematoma. Metabolic causes included drug overdose, acute alcohol intoxication, hypoglycaemia, sepsis, and pneumonia. It was metabolic in 69 patients (60%) and structural in 46 patients (40%). Results: Aetiology of coma was determined in 98% of the patients. One year follow up was obtained in all patients. Assignment of aetiology of coma was based on strict adherence to predetermined criteria and achieved by consensus of the two physician investigators. Patients underwent structured clinical examinations and laboratory and imaging tests. Patients and methods: One hundred and fifteen consecutive patients presenting with coma were enrolled in this prospective cohort during the 12 month study period in the emergency room of a community teaching hospital. Objectives: To determine the usefulness of bedside evaluation of pupils in determining the aetiology of coma by adopting a probabilistic approach. ![]()
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