Having these conditions in mind, the patient is examined from head to foot in the following manner:—
The vault of the skull is first examined and all evidence obtained as to the presence and extent of external injury.
The ears and nose are investigated for escaping blood or cerebro-spinal fluid, important symptoms in the diagnosis of fracture of the base.
The eyes are next examined. Ocular palsies suggest injury or apoplexy; hæmorrhages—subconjunctival or palpebral—point to injury; whilst the condition of the pupils and disks may offer valuable information. Thus:
In concussion, the pupils are equal, dilated, but responsive to light.
In irritation, they are equal but contracted.
In compression, they are either equal, dilated and fixed, or unequal.
In alcohol, they are more or less normal, except in the deeper stages of intoxication, when they are dilated and irresponsive to light.
In apoplexy, dilated and fixed, or unequal. Pin-point in pontine hæmorrhage.
In epilepsy, usually equal and responsive.