Neurological Examination of the Unconscious Patient

All unconscious patients should have neurological examinations to help determine the site and nature of the lesion, to monitor progress, and to determine prognosis. The examination consists of observing the patient and eliciting reflexes. We have provided a scheme for the bedside neurological examination of the unconscious patient that can be easily and quickly executed and is easy to interpret. We have not tried to provide a comprehensive pathophysiology of coma; for a more detailed discussion see Plum and Posnert. The Glasgow coma scale should be completed (Table 1) and a coma chart initiated to monitor pupillary reactions, pulse, temperature and blood pressure. Neurological examination is most useful in the well-oxygenated, normotensive, normoglycaemic patient with no sedation, since hypoxia, hypotension, hypoglycaemia and sedating drugs profoundly affect the signs elicited.