Published 22 July 2009, doi:10.1136/bmj.b2864
Cite this as: BMJ 2009;339:b2864

Endgames

Case report

Black and blue . . . and unconscious

Marieke van Onna, resident in internal medicine, Thomas van Bemmel, internist, Erik van Wensen, neurologist, Cees Schaar, internist-haematologist, Hein Slis, radiologist, Peter E Spronk, internist-intensivist

1 Department of Intensive Care Medicine, Gelre Hospitals, 7334 DZ Apeldoorn, Netherlands

Correspondence to: P E Spronk p.spronk@gelre.nl

The first 150 words of the full text of this article appear below.

A comatose 29 year old male was brought to the emergency department of our hospital. The patient was an international truck driver, and he and his co-driver had slept the night before in their truck at a car park near the motorway. The next morning, the co-driver found the patient in a comatose state in the sleep cabin of their truck. The attending neurologist observed a Glasgow coma score of four (E1-M2-V1) with fixed dilated pupils and no cornea and ocular cephalic brainstem reflexes. Furthermore, the patient had multiple petechiae on the left side of the throat and symmetrical bruises on the anterior medial side of both upper legs. Otherwise, physical investigation was unremarkable.

1 What initial investigations are appropriate?
2 What is the most likely diagnosis?

1 The initial investigations should include brain computed tomography and a limited panel of laboratory tests.
2 The most likely causes of coma . . . [Full text of this article]


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