We agree with Ikeda et al that the absence of systolic hypertension may provide some discriminatory power towards exclusion of brain lesions, be they ischaemic, haemorrhagic, or space occupying in nature.1 However, we disagree with them that neurological examination of patients with impaired consciousness is often a waste of time and resources and can delay diagnosis.
Whelan, K. R., Jones, A. L. & Dargan, P. I. (2003). Drug misuse should always be considered in young people with impaired consciousness. British Medical Journal, 326 (7385), 396-397.