Location of Level of Brain stem Dysfunction

How does the clinical examination localize the level of brain stem dysfunction in a comatose patient?

Location of Level of Brain stem Dysfunction

Symptoms and SignsSubcorticalMidbrainPonsMedulla
ConsciousnessLethargy or stuporComaComaComa
BreathingCheynes–StokesCentral hyperventilationApneustic or clusterAtaxic
PupilsSmall and reactiveMidposition and fixed (III nucleus); unilateral dilated and fixed (III nerve); large and fixed (pretectal)PinpointMidposition and fixed, often irregular in shape
Oculocephalic and oculovestibular responsesPresentAbsent or abnormalAbsent or abnormalAbsent
Motor response to stimulationDecorticationDecerebrationDecerebration or no responseNo response

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