Clinical Presentation

Case: An unconsci ous adol escent ?

16 year-old-girl found in bed unresponsive
She would not awaken to voice
With vigorous shaking she opened her eyes
and moaned
When not stimulated she closed her eyes and
continued breathing
Case: An unconsci ous adol escent ?
o What is her mental status?
Stupor
o Possible causes?
Deep sleeper?
Intoxication?
Something worse?
Depressed consci ousness: 3 causes
From Neurology
through Clinical Cases:
H. Blumfeld
There are 3 causes of
depressed
consciousness
1. Structural
Case: An unconsci ous adol escent ?
There are 3 causes of depressed
consciousness
1. Structural
2. Metabolic
3. Seizure
From Neurology through Clinical Cases: H. Blumfeld
Decorticate
Posturing
(Arms flex)
Decerebrate
Posturing
(Arms
Extend)
No Posturing
Neuro Exam
Responsiveness voice or
pain
Motor response to pain
From Neurology through Clinical Cases: H. Blumfeld
Neuro Exam
Responsiveness voice or
pain
Motor response to pain
Brainstem exam:
Pupils
Corneal reflex
Dolls eyes
Caloric testing
Cough / gag
Hypoglycemia
Hypothermia
glucose
O
2
Krebs
Mitochondria
ATP
Na
+
Hyponatremia
Hypoxemia
Drugs- synaptic level
Sedative/hypnotic
Opiates/ TCAs
Global ischemia
Other
Meningitis/ encephalitis
Myxedema/ Hepatic
Status epilepticus