The patient is a 19-year-old man, brought to the emergency department with loss of consciousness. Apparently the patient was a homeless found on the street. Vital signs at the first visit were Blood Pressure 90/60 mm Hg, Respiratory Rate 12/min, pulse 71 beats/min and axillary temperature 36.8C. On physical exam, he was obtunded with no evidence of trauma or limb deformity. The pupils were bilaterally dilated, fixed and non reactive with no icterus. The lungs were symmetrically clear and S1 and S2 were heard without murmur or gallop. Bowel sounds were present and abdomen was soft without distention. On fundoscopy, he had bilateral papilledema with disc hyperemia. Doll`s eye was positive and cornea reflex and gag reflex were symmetrically positive. Plantar reflex in the right was upward and in the left was downward.
Key words: Coma, basal ganglia infarct
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