Obtundation: blunting of arousal ("sleepy").
Stuporous: rousable with painful stimulus.
Circumstances? Unwell? PMH? Drugs/toxins?
General examination: skin—needle tracks, snout rash;
Head injury? (look through hair, in ears, nose)
Eyes: movements, pupils, fundi, corneal reflex
Gaze deviation, dysconjugate gaze, skew, roving, ocular bobbing
Doll's eye reflex, calorics
Full screen: FBC U&E LFT toxins (EtOH, paracetamol, aspirin).
Others as indicated
No focal signs, no meningism
Metabolic, diffuse anoxia/ischaemia, drug, toxin.
No focal signs, meningism
Meningitis, encephalitis, subarachnoid haemorrhage
focal signs, meningism