Spindle coma is an electroclinical entity that has been used to describe an EEG pattern of “sleep-like” activity in comatose patients. Although it has been associated with favourable prognosis, its aetiology is one of the key factors for patient outcome. The authors present three cases of spindle coma with different aetiologies (amitriptyline overdose, pontine myelinolysis and hypoxic-ischaemic encephalopathy) that culminated in different outcomes.LEARNING POINTSSpindle coma (SC) is an electroclinical “sleep-like” pattern that appears in comatose patients.It implies the functional preservation of the cerebral hemispheres which can be associated with a good prognosis.The aetiology of SC is a key factor for outcome.

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