Nontraumatic coma in children and adolescents: diagnosis and management.

The causes of nontraumatic coma (NTC) vary by country, season and period of data collection. Infective diseases are among the major worldwide causes of NTC. Nonaccidental head injury must be in the differential diagnosis. Genetic and ethnic susceptibilities to causes of coma are being recognized. A systematic history and examination are essential for diagnosis, early recognition of herniation syndromes, and management. The management of NTC is discussed, with reference to clinical approach, treatment of seizures, and increased intracranial pressure. Public health measures, education, early diagnosis, and prompt appropriate treatment are the foundations needed to reduce incidence and improve outcome.