Case 14 - coma and dilated pupil
Clinical formulation
Acute onset coma, with right exotropia and pupil dilatation suggestive of III palsy, and concern for left hemiparesis – most likely due to a vascular lesion, with the chief suspicion being a large right intracerebral haemorrhage. Less likely possibilities include a deep aneurysmal subarachnoid haemorrhage or basilar artery occlusion. Urgent imaging is essential.
Outcome