Prolonged Coma After Head Injury

Crompton, M. R.; Teare, R. Donald; Bowen, DavidA.L.

doi:10.1016/s0140-6736(66)90538-1

Cited by 20 publications

(5 citation statements)

References 3 publications

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“…Necropsy reports have been published on 43 patients who had prolonged unconsciousness similar to our cases (French, 1952;Jacobson, 1956;Strich, 1956;Denst et al, 1958;Nystrbm, 1960;Strich and Oxon, 1961;Jellinger et al, 1963;Utsumi et al, 1963;Nakamura et al, 1965b;Crompton et al, 1966;Arai and Ueki, 1971;Okada et al, 1972). The clinical condition in these cases before death had been in keeping with our criteria for a vegetative state.…”

Section: Discussionsupporting

confidence: 80%

“…There is no standardised terminology for such a state resulting from severe brain damage, although various names have been applied, such as prolonged coma (Nakamura et al, 1965a,b;Crompton et al, 1966), coma vigile (Gerstenbrand, 1967), parasomnia (Jefferson, 1944), akinetic mutism (Cairns et al, 1941), and apallic syndrome (Kretschmer, 1940). Recently, Jennett and Plum (1972) proposed that this syndrome should be described as a persistent vegetative state.…”

mentioning

confidence: 99%

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Epidemiological studies on patients with a persistent vegetative state

Higashi

Sakata

Hatano

et al. 1977

Journal of Neurology, Neurosurgery & Psychiatry

112

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(Nakamura et al., 1965a,b;Crompton et al., 1966), coma vigile (Gerstenbrand, 1967), parasomnia (Jefferson, 1944), akinetic mutism (Cairns et al., 1941), and apallic syndrome (Kretschmer, 1940). Recently, Jennett and Plum (1972) We arbitrarily designed the following criteria in order to study such patients: (1) defect of verbal and behavioural communication; (2) loss of expression of intention; (3) absence, or at least reduction of emotional expression; (4) urinary and faecal incontinence; (5) complete loss of selfsupportability; (6) continuation of above conditions for more than three months, regardless of causative disease. Patients and methodsIn response to simple inquiries to 269 hospitals in 16 prefectures of western Japan on 1 June 1973, 193 potentially suitable cases were reported from 189 hospitals; we then visited each hospital and examined each patient. Based on the above criteria, 110 patients were included in our study.Although we were unable to assess the incidence of vegetative patients for all districts responding to our inquiry our survey did cover all hospitals within Yamaguchi prefecture, a population of approximately 1.5 million. We found 37 vegetative patients, an incidence of 0.0025%.We examined the behaviour, response to various stimuli, and neurological signs of the 110 patients in our sample. Analyses were also made of the results of ancillary examinations, methods of management of the patients, and effectiveness of treatment given. In order to assess the level of 876

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Section: Discussionsupporting

confidence: 80%

mentioning

confidence: 99%

Epidemiological studies on patients with a persistent vegetative state

Higashi

Sakata

Hatano

et al. 1977

Journal of Neurology, Neurosurgery & Psychiatry

112

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“…In the 1950s, Sabrina Strich performed seminal histopathological studies revealing that patients with post-traumatic disorders of consciousness experienced axonal degeneration not just in the cerebral hemispheres and subcortical white matter, but also within the brainstem [1]. Consistent with observations by Strich, subsequent investigators identified associations between brainstem lesions and poor neurological outcomes, including prolonged disorders of consciousness and death [2–4]. J. Hume Adams refined the conceptual model of TAI (also referred to as “diffuse axonal injury”) by proposing three categories in which the most severe injury, “grade 3,” was associated with focal lesions in the brainstem [5].…”

Section: Introductionmentioning

confidence: 93%

Revisiting Grade 3 Diffuse Axonal Injury: Not All Brainstem Microbleeds are Prognostically Equal

et al. 2017

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Background Recovery of functional independence is possible in patients with brainstem traumatic axonal injury (TAI), also referred to as “grade 3 diffuse axonal injury,” but acute prognostic biomarkers are lacking. We hypothesized that the extent of dorsal brainstem TAI measured by burden of traumatic microbleeds (TMBs) correlates with 1-year functional outcome more strongly than does ventral brainstem, corpus callosal, or global brain TMB burden. Further, we hypothesized that TMBs within brainstem nuclei of the ascending arousal network (AAN) correlate with 1-year outcome. Methods Using a prospective outcome database of patients treated for moderate-to-severe traumatic brain injury (TBI) at an inpatient rehabilitation hospital, we retrospectively identified 39 patients who underwent acute gradient-recalled echo (GRE) MRI. TMBs were counted on the acute GRE scans globally and in the dorsal brainstem, ventral brainstem, and corpus callosum. TMBs were also mapped onto an atlas of AAN nuclei. The primary outcome was the Disability Rating Scale (DRS) score at 1 year post-injury. Associations between regional TMBs, AAN TMB volume, and 1-year DRS score were assessed by calculating Spearman rank correlation coefficients. Results Mean+/−SD number of TMBs were: dorsal brainstem=0.7+/−1.4, ventral brainstem=0.2+/−0.6, corpus callosum=1.8+/−2.8, and global=14.4+/−12.5. The mean+/−SD TMB volume within AAN nuclei was 6.1+/−18.7 mm3. Increased dorsal brainstem TMBs and larger AAN TMB volume correlated with worse 1-year outcomes (R=0.37, p=0.02, and R=0.36, p=0.02, respectively). Global, callosal, and ventral brainstem TMBs did not correlate with outcomes. Conclusions These findings suggest that dorsal brainstem TAI, especially involving AAN nuclei, may have greater prognostic utility than the total number of lesions in the brain or brainstem.

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“…They introduced the term because they were generally unhappy about the other terms used at the time. These terms either use categories which were not true, eg, prolonged coma 3 4 or coma vigil5 (when the patients, by definition, were not in coma), or were of specific syndromes, eg, decerebrate dementia,6 parasomnia,7 or akinetic mutism 8. The term apallic syndrome,9still used in Germany, implies lack of the cortex which may not be the case, especially in traumatic injuries.…”

Section: Terminologymentioning

confidence: 99%

The vegetative state – clinical diagnosis

Andrews

1999

Postgraduate Medical Journal

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Prolonged Coma After Head Injury

Cited by 20 publications

References 3 publications

Epidemiological studies on patients with a persistent vegetative state

Epidemiological studies on patients with a persistent vegetative state

Revisiting Grade 3 Diffuse Axonal Injury: Not All Brainstem Microbleeds are Prognostically Equal

The vegetative state – clinical diagnosis

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