Harrison's Manual of Medicine
17/e
Table 17-2: Differential Diagnosis of Coma
·
Diseases that cause no focal or lateralizing neurologic
signs, usually with normal brainstem functions; CT scan and cellular content of
the CSF are normal
o
Intoxications: alcohol,
sedative drugs, opiates, etc.
o
Metabolic disturbances:
anoxia, hyponatremia, hypernatremia,
hypercalcemia, diabetic acidosis, nonketotic
hyperosmolar hyperglycemia, hypoglycemia, uremia,
hepatic coma, hypercarbia, addisonian
crisis, hypo- and hyperthyroid states, profound nutritional deficiency
o
Severe systemic
infections: pneumonia, septicemia, typhoid fever, malaria, Waterhouse-Friderichsen syndrome
o
Shock from any cause
o
Postseizure states, status epilepticus,
subclinical epilepsy
o
Hypertensive
encephalopathy, eclampsia
o
Severe hyperthermia,
hypothermia
o
Concussion
o Acute hydrocephalus
·
Diseases that cause meningeal
irritation with or without fever, and with an excess of WBCs or RBCs in the
CSF, usually without focal or lateralizing cerebral or brainstem signs; CT or
MRI shows no mass lesion
o
Subarachnoid
hemorrhage from ruptured aneurysm, arteriovenous
malformation, trauma
o
Acute bacterial
meningitis
o
Viral encephalitis
o
Miscellaneous: Fat
embolism, cholesterol embolism, carcinomatous and lymphomatous meningitis, etc.
·
Diseases that cause focal brainstem
or lateralizing cerebral signs, with or without changes in the CSF; CT and MRI
are abnormal
o Hemispheral hemorrhage (basal ganglionic, thalamic) or infarction (large middle cerebral
artery territory) with secondary brainstem compression
o Brainstem infarction due to
basilar artery thrombosis or embolism
o Brain abscess, subdural empyema
o Epidural and subdural
hemorrhage, brain contusion
o Brain tumor with surrounding
edema
o Cerebellar and pontine
hemorrhage and infarction
o Widespread traumatic brain
injury
o Metabolic coma (see above)
with preexisting focal damage
o Miscellaneous: cortical vein
thrombosis, herpes simplex encephalitis, multiple cerebral emboli due to
bacterial endocarditis, acute hemorrhagic leukoencephalitis, acute disseminated (postinfectious)
encephalomyelitis, thrombotic thrombocytopenic purpura,
cerebral vasculitis, gliomatosis
cerebri, pituitary apoplexy, intravascular lymphoma,
etc