EMQ: 29
Loss of consciousness
a)
Subdural haematoma
b)
Encephalitis
c)
Subarachnoid haemorrhage
d)
Status epilepticus
e)
Meningitis
f)
Intracerebral haemorrhage
g)
Hypoglycaemia
h)
Diabetic ketoacidosis
i)
Carbon monoxide poisoning
j)
Heroin overdose
1)
An 18 year old male who is an insulin dependent diabetic is brought
into casualty by his friends. He has been found unconscious in his room at the
university halls of residence in the morning. On examination he does not look
dehydrated, he is not rousable even when painful stimuli are used, his
respiratory rate is 15 breaths per minute and not deep.
Answer g) hypoglycaemia
It is likely that he developed
hypoglycaemia as he has been found in the room in the morning presumably
before breakfast. It is not diabetic ketoacidosis as he is not dehydrated and
not apparently acidotic as his respiration is normal (one would have expected
Kussmaul’s respiration if he was in diabetic ketoacidotic coma)
2) An 80-year-old male who has
been having frequent falls presents with a fluctuating level of consciousness
noted by the carers at the nursing home he lives in. On clinical examination
there are no neurological signs.
Answer a) subdural haematoma
Falls would predispose an
elderly patient to subdural haemorrhage and the fluctuating level of
consciousness is one of the features of this condition.
3) A 56-year-old male who has hypertension
for which he has not been taking medication presents with a history of
headache, nausea and vomiting and left sided weakness of sudden onset.
Answer: f) Intracerebral
haemorrhage
Uncontrolled hypertension
would predispose the patient to an intracerebral haemorrhage, which could
cause a stroke. The history of headache, nausea and vomiting in association
with stroke would make haemorrhage more likely.
4)
A
22-year-old university student is admitted with fever and a rash. On
examination he is febrile, has a haemorrhagic, rash he is drowsy and there is
neck stiffness.
Answer: e) meningitis
Fever and rash with loss of
consciousness and neck stiffness should make one think of meningococcal
meningitis
5) A
45-year-old female presents with a history of sudden onset occipital headache
followed by a deteriorating level of consciousness. On examination there is
neck stiffness.
Answer: c) subarachnoid
haemorrhage
Sudden onset of occipital
headache should make one think of subarachnoid haemorrhage and this is
confirmed by the fact that the patient has neck stiffness
Revision Tip
Revise the causes of loss of
consciousness ACES for PACES pages 456
-457
