• Santiago Ortega-Gutierrez, Thomas Wolfe, Dhruvil J Pandya, Viktor Szeder, Marta Lopez-Vicente, and Osama O Zaidat.
• Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.
• Neurologist. 2009 Sep 1; 15 (5): 254-67.

BackgroundNeurologists are frequently called to evaluate patients in the intensive care units who are not waking up. This often poses a diagnostic and prognostic dilemma.Review SummaryThe initial evaluation starts with abstracting the prehospital and in-hospital history, followed by bedside clinical and neurologic examination to establish a differential diagnosis. The subsequent work-up is based on clinical suspicion where reversible life-threatening causes should be immediately identified. After confirming the diagnosis and implementation of the appropriate medical management, a prompt family meeting and counseling is recommended. The role of neurologists in clinical diagnosis and prognostication of the coma patient, as well as diagnosing brain death is instrumental.ConclusionsIn this review, we explore a practical systematic approach to patients with decreased level of consciousness. The most common causes of impaired alertness in different non-neurologic critical care units and commonly used prognostication tools are presented. Finally a brief introduction of hypothermia, a novel therapeutic approach is also discussed.

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