DECEREBRATE POSTURING IN ALCOHOLIC COMA

Two cases of alcoholic coma are presented where extensor responses to noxious stimuli are demonstrated. Decerebrate posturing normally indic ates severe structural or functional depression of mid-brain function but can be caused by depressant drugs. Blood alcohol measurements are a vital test in the comatose patient as the clinical picture may be ca used, or temporarily significantly worsened, by severe alcohol intoxic ation. The preservation of pupillary light reflexes in the presence of deep coma with decrebrate posturing should alert the clinician to a p ossible metabolic cause for the coma, including alcohol. Nevertheless, a diagnosis of alcoholic coma should not be made unless the blood alc ohol concentration is grossly elevated and other causes of coma have b een excluded by careful physical examination, blood glucose and electr olyte measurement, skull radiography and, in the absence of a rapid im provement, computerized tomography.