Internal Medicine

0521779407-C03 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:54

370 Colon Polyps and Tumors Coma

Prognosis

■removal of adenomas is associated with reduced incidence of CRC

(National Polyp Study)

■screening asymptomatic individuals over age 50 can reduce CRC

mortality (RCTs with FOBT and case-control studies with sigmoi-

doscopy)

Coma.............................................

MICHAEL J. AMINOFF, MD, DSc

history & physical

■Unresponsive & unarousable

■Cause may be suggested by mode of onset (acute or insidious)

■May relate to past medical or psychiatric history, medication or drug

use, history of trauma

■Response to pain or other stimuli depends on depth of coma

■Signs of bihemispheric or brain stem dysfunction may be present

■Structural lesions may cause unequal pupils, dysconjugate eye

movements, papilledema, focal deficits

■Metabolic or toxic cause, subarachnoid hemorrhage or meningi-

tis produces preserved pupillary & eye movement reflexes, no focal

deficits in limbs

tests

■See “Confusion”

differential diagnosis

■Sudden onset of coma suggests vascular cause (eg, SAH)

■Rapid progression from focal hemispheric deficit to coma suggests

ICH

■Absence of focal or lateralizing signs suggests SAH, meningitis or

metabolic/toxic encephalopathy

■Persistent vegetative state is distinguished by occurrence of sleep/

wake cycles

■In de-efferented state, pt is awake, alert, mute, quadriplegic; mid-

brain movements (eg, voluntary eye opening) are preserved & EEG

is normal

management

■Supportive care