Untersuchung des Bewusstlosen: Hirnstammsyndrome und Hirndruck

Examination of the unconscious patient aims at assessing the coma level (eye opening, pain response) and brainstem reflexes (e.g. pupillary light reflex, gag/tracheal reflex). The findings provide the basis for a preliminary evaluation of the severity of a structural brain lesion. Regular reevaluation and observation of the clinical course is predictive for the outcome. Knowledge of neuroanatomical landmarks makes so called brainstem syndromes understandable. Severe cerebral damage frequently results in increased intracranial pressure. Thus, neuroprotective action such as correct positioning, oxygen treatment, respiratory and circulatory stabilisation should already be taken at the preclinical level.