A case of coma patient
A 43 year old man currently in our intensive care with coma. He had presented with a history of Hypertension (1 reading on 200/120 a few days back) and on the day of presentation had Headache, vomiting and Hyponatremia (104 MeQ) with seizures immediately after admission followed by coma with fixed and dilated pupils and respiratory failure requiring ventilation in ICU. CT head done later was suggestive of Diffuse cerebral edema. Provisional diagnosis was Brain stem stroke. The next day on review, Brain stem reflexes present (pupils, doll's eye/oculocephalic reflexes were present). Plan was to wean off sedation and evaluate neurological recovery with time and Mannitol and ventilation to continue.
31st October morning: Hyponatremia is gradually getting controlled on slow 3% correction over the last 2 days with sodium currently at 124. He is still comatose with intact brainstem reflexes. Queries: What is the role of Cranial MRI in detecting brain stem infarcts in this scenario? Would EEG help in throwing further light ?