The approach to a comatose patient should be organized and initially focused on treatable causes. Having a checklist (written or just mental) is very useful to avoid missing possible diagnoses or tests that should be conducted. On the other hand, indiscriminate testing is ill-advised because it can result in misdiagnosis from false-positive results in addition to sometimes exposing the patient to unnecessary risks and increasing costs of care. Empiric treatment is sometimes indicated, such as in the case of possible bacterial meningitis or HSV-1 encephalitis, until certain diagnoses can be excluded. Prognosis depends on diagnosis and should generally not be discussed before a diagnosis is established. This chapter provides a brief overview and practice recommendations for the diagnosis, treatment, and prognosis of the most common causes of acute coma in adult patients.
KeywordsComa Acute Diagnosis Treatment Prognosis
- 1.Rabinstein AA. Coma and brain death. Continuum (Minneap Minn). 2018;24(6):1708–31.Google Scholar
- 16.Charry JD, Tejada JH, Pinzon MA, et al. Predicted unfavorable neurologic outcome is overestimated by the Marshall Computed Tomography Score, Corticosteroid Randomization After Significant Head Injury (CRASH), and International Mission for Prognosis and Analysis of Clinical Trials in Traumatic Brain Injury (IMPACT) models in patients with severe traumatic brain injury managed with early decompressive craniectomy. World Neurosurg. 2017;101:554–8.CrossRefGoogle Scholar