differential diagnosis of coma
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Differential diagnosis
normal brainstem reflexes, no lateralizing signs
- CT or MRI normal
- hemispheric lesions found by CT or MRI
- hydrocephalus
- bilateral subdural hematoma
- bilateral contusions, edema or axonal shearing of hemispheres due to closed head trauma
- subarachnoid hemorrhage
- acute disseminated encephalomyelitis
normal brainstem reflexes, lateralizing motor signs (CT or MRI abnormal)
- unilateral mass lesion
- cerebral hemorrhage (basal ganglia, thalamus)
- large infarction with surrounding brain edema
- herpes viral encephalitis (temporal lobe lesion)
- subdural or epidural hematoma
- tumor with edema
- brain abscess with edema
- vasculitis with multiple infarctions
- metabolic encephalopathy superimposed on pre-existing focal lesions (i.e. stroke with hyperglycemia or hyponatremia, etc)
- pituitary apoplexy
- asymmetric signs accompanied by diffuse hemispheric dysfunction
multiple brainstem reflex abnormalities
- anatomic lesions in brainstem
- pontine or midbrain hemorrhage
- cerebellar hemorrhage, tumor, abscess
- cerebellar infarction with brainstem compression
- mass in hemisphere causing advanced upper brainstem compression
- primary brainstem tumor, demyelination or abscess
- traumatic brainstem contusion-hemorrhage
- brainstem dysfunction without mass lesion
More general terms
Additional terms
References
- ↑ Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 133