Immediate assistants history and circumstances of the disease give valuable clue to the diagnosis. Some important factors of exams: Oculocephalic (reflection of eye movements), conjugate deviation of eyes, testing The calorie, position the patient and Funduscopy reflexes. General examination should raise the following characteristics:
1 Evidence of trauma
2 Bleeding from the nose and ears, suggesting the base of the skull fracture
3. The pallor and shock indicating the recent loss of blood
4 Smell alcohol and evidence of intoxication.
5 Signs of repeated venipuncture seen in drug intravenously.
6 Type of acid breath breathing, Cheyne - stokes breathing or respiratory depression.
7. The presence of systemic illnesses as diabetes, kidney disease, liver failure, hypertension, cardio-vascular lesions that can act as sources of emboli, etc.
8. The seizure disorders, for example, epilepsy.
9. Signs of systemic or intracranial infections.
10. After to determine the overall health of the patient and the depth of the coma, systematic neurological examination should be carried.
11. Students: the inequality of the students suggested anomaly. The dilated pupil does not react is the result of oculomotor, which may be due to a participation of nerve or its cores in mid-brain paralysis.
The pupils reagent bilateral pinpoint light are seen in Pontine nuclei of bleeding.Pinpoint pupils can see as well in narcotic intoxication (e.g. morphine).
Reflections from Oculocephalic (reflection of eye movements): these are tested, turning the head firmly on both sides by 70 degrees and then passively bend and extend your neck.Eye on the movement of the cabeza.estos movement "Doll eye movement depend on the intactness of the third, fourth and sixth cranial nerve nuclei, the labyrinth, Otoliths and its central connections in the brain stem including kernels vestibular and medial longitudinal fasciculi".Preservation of the "Doll eye movement" helps the disease of the brain stem exclusion.Unilateral absence of movement of the doll eyes suggests ipsilateral injury Pontine. wrist eye movements are completely abolished in large structural damage in the brain stem and the status of metabolic deep coma.
Deviation from the eyes of the conjugate: this should be sought.Lateral deviation of conjugate occurs in brain lesions or Pontine.Conjugate diversion is to the side of the lesion in destructive disorders and contralateral side in voiding disorders in cortical injuries.Pontine injury occurs.In tectal and kernels, injuries are depression the eyeballs.In injuries to the brain stem, vertical nystagmus spontaneity and diversion of bias may ocurrir.Los eyeballs are diverted to the side in cerebellar haemorrhage.
Caloric testing: these tests provide information for the integrity of the vestibular apparatus its connections with the major State corticales.En coma ever deeper, when the cortical function gradually becomes depressed, the rapid phase of the nystagmus centers tends to disappear.
Position of the patient: bending the upper limb and extension of the lower limbs occur in the cortical or subcortical lesions than mid-brain (posture decorticate) .when all four extremities are extended, rigid and adducted, this is known as position decerebrate. the lesion is in the brain stem between the superior colliculus and vestibular kernel.
Funduscopy: This procedure must be performed in all cases to exclude papilledema and compulsory retina.Es anomalies to exclude high intracranial pressure before they tried a lumbar puncture.
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