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Table 2 Correlation of localization and clinical signs in comatose states

From: Coma and cerebral imaging

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