Coma
- 30 March 2009
- journal article
- review article
- Published by Wiley in Annals of the New York Academy of Sciences
- Vol. 1157 (1), 32-47
- https://doi.org/10.1111/j.1749-6632.2009.04471.x
Abstract
Coma is a state of unarousable unconsciousness due to dysfunction of the brain's ascending reticular activating system (ARAS), which is responsible for arousal and the maintenance of wakefulness. Anatomically and physiologically the ARAS has a redundancy of pathways and neurotransmitters; this may explain why coma is usually transient (seldom lasting more than 3 weeks). Emergence from coma is succeeded by outcomes ranging from the vegetative state to complete recovery, depending on the severity of damage to the cerebral cortex, the thalamus, and their integrated function. The clinical and laboratory assessments of the comatose patient are reviewed here, along with an analysis of how various conditions (structural brain lesions, metabolic and toxic disorders, trauma, infections, seizures, hypothermia, and hyperthermia) produce coma. Management issues include the determination of the cause and reversibility (prognosis) of neurological impairment, support of the patient, definitive treatment when possible, and the ethical considerations for those situations where marked disability is predicted with certainty.Keywords
This publication has 28 references indexed in Scilit:
- Prognostic Value of Evoked Responses and Event-Related Brain Potentials inCanadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques, 2004
- Sleep, consciousness and the spontaneous and evoked electrical activity of the brain. Is there a cortical integrating mechanism?Neurophysiologie Clinique/Clinical Neurophysiology, 2003
- The ascending reticular activating system — from aminergic neurons to nitric oxideJournal of Chemical Neuroanatomy, 2000
- Clinicopathologic Correlation in a Case of Pupillary Dilation From Cerebral HemorrhageArchives of Neurology, 1991
- The significance of myoclonic status epilepticus in postanoxic comaNeurology, 1990
- The opposite pupil in herniationNeurology, 1990
- A preliminary MRI study of the geometry of brain displacement and level of consciousness with acute intracranial massesNeurology, 1989
- Lateral Displacement of the Brain and Level of Consciousness in Patients with an Acute Hemispheral MassThe New England Journal of Medicine, 1986
- Acute Brain Herniation: A Revised ConceptSeminars in Neurology, 1984
- Über örtliche Veränderungen der Konfiguration des Gehirns beim HirndruckArchiv Fur Psychiatrie Und Nervenkrankheiten, 1938