Final answer:
In cases of coma with a structural cause, dilated, unequal, or even reactive pupils may be observed, depending on the location and extent of the injury.
Step-by-step explanation:
When dealing with a structural cause of a coma, such as trauma or mass effect from a tumor or hemorrhage, the pupils can exhibit various changes depending on the location and severity of the injury. Typically, you might observe:
- Dilated pupils, especially if there is increased intracranial pressure causing compression of the third cranial nerve.
- Pinpoint pupils, although this is more commonly associated with specific types of drug overdose or damage to the pons.
- Reactive pupils may still be present if the structural damage has not affected the pathways controlling pupil response.
It is important to note that the presence of dilated or unequal pupils is a serious sign indicating potential brain herniation and requires immediate medical intervention.