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Impaired Consciousness and Coma 

Impaired Consciousness and Coma
Impaired Consciousness and Coma
Mayo Clinic Neurology Board Review: Clinical Neurology for Initial Certification and MOC

S. Arthur Moore

and Eelco F. M. Wijdicks


Impaired consciousness and coma can result from multiple causes. Clues to the cause may be ascertained from the initial history and physical examination. In patients with coma, the examination focuses on the level of consciousness and arousal, respirations, pupillary and extraocular eye movement findings, and motor response. When all brain and brainstem functions cease and there is a known, irreversible brain injury responsible, the condition is referred to as brain death. This chapter reviews the anatomy of consciousness and provides historical and physical examination clues to determining the cause of impaired consciousness. Aspects of the neurologic examination important for coma and brain death are discussed.

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