Case history

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.

Questions

• 1 What initial investigations are appropriate?

• 2 What is the most likely diagnosis?