CASE 75: UNCONSCIOUS AT HOME
History
A 21-year-old man is brought in to hospital at 5 pm. He was found unconscious in his flat
by his girlfriend. She had last seen him at 8 pm the evening before when they came home
after Christmas shopping. When she came to see him the next afternoon she found him
unconscious on the floor of the bathroom. He had been well previously, with no known
medical history. There was a family history of diabetes mellitus in his father and one of
his two brothers.
His girlfriend had said that he had shown no signs of unusual mood on the previous day.
He had his end of term examinations in psychology coming up in 1 week and was anx-
ious about these but his studies seemed to be going well and there had been no problems
with previous examinations.
He is a non-smoker. He drinks around 10 units of alcohol most weeks with occasional
binges. He has taken ecstasy tablets in the past but has never used intravenous drugs.
Examination
He looked pale. There were no marks of recent intravenous injections. His pulse was
92/min, blood pressure 114/74 mmHg, respiratory rate 22/min. There were no abnormalities
to find in the cardiovascular or respiratory systems. In the nervous system there was no
response to verbal commands. Appropriate withdrawal movements were made in response
to pain. The reflexes were brisk and symmetrical, plantars were downgoing. The pupils
were dilated but responsive to light. In the fundi, the optic discs appeared swollen.
Questions
- What are the most likely diagnoses?
- What other investigations should be done immediately?