Localization of lesion leading to coma | Clinical findings |
---|---|
Coma with bilateral hemispheric lesions | Quadriparesis with symmetrical alteration of muscle tone and reflexes (extensor and flexor posturing, Babinski’s sign) |
Seizures, myoclonus possible | |
Brain stem and pupillary reflexes are intact | |
Coma with unilateral supratentorial lesion and secondary brain stem lesion | Ipsilateral oculomotor nerve palsy and contralateral hemiparesis evolving to quadriparesis |
Coma with primary brain stem lesion | Quadriparesis with an asymmetrical muscle tone und reflex abnormalities (extensor and flexor posturing Babinski’s sign) |
Pathological brain stem reflexes | |
Coma due to toxic and metabolic disease | Tetraparesis with symmetrical muscle tone and reflex abnormalities (extensor and flexor posturing Babinski’s sign) |
Pathological brain stem reflexes and pupillary reflexes intact (except in opiate or sympathicomimetic intoxications) | |
Myoclonus or seizures possible |