COMA NEUROLOGIC EXAM TEMPLATE

An example of a comprehensive coma exam in a patient with psychogenic coma:

 

General:

-description – lying supine, well-dressed

-breathing pattern – normal

-breath odor – normal

Head atraumatic normocephalic

Eyes:

-eyes midline and conjugate without deviation

-pupils 2mm, equally reactive

-eyes squint to bright light

-fundoscopy – unable to perform due to eye movement

-purposeful movements detected

Oropharynx – mucus membranes moist

Neck – no meningismus

Chest cta bilat

Heart rrr no mrg

Abd soft, nt, no om

Extremities – warm, no atrophy

Neurologic examination:

Mental status:

-level of consciousness – unreactive

-no receptive or expressive language

Motor:

-muscle tone normal, not atonic, not increased

-not following motor commands

Sensory:

-withdraws to pain in all 4 extremities

Reflexes:

-DTRs symmetrical

-Babinski down bilaterally

Cranial nerves:

II – visual threat – blinks. Eye squints to bright light.

III, IV, VI – does not track.  Oculocephalic reflexes reveal intact motor movements.

V – corneal reflex intact, nares tickling provokes grimace

VII – supraorbital nerve compression yields symmetrical facial grimace

VIII – voice stimulation in ear provokes flinch

IX/X – gag reflex intact

XI/XII – not possible to reliably examine

GCS:

Motor: purposeful movement to pain

Verbal – no response

Eyes – closed

Coma tests:

Cold calorics reveal nystagmus with fast phase away from the ice

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