Biomaterial Database

Disorders of consciousness: differential diagnosis and neuropathologic features. 1997

J T Giacino

JFK Johnson Rehabilitation Institute, Edison, New Jersey, USA.

Disorders of consciousness present intriguing challenges to the neurologist and neurorehabilitation specialist. Assessment is constrained by the lack of reliable methods of assessing consciousness, and there are no treatment interventions known to influence the course of recovery from these conditions. In addition, the relationship between the clinical features associated with these disorders and their corresponding pathophysiologic substrate is also unclear. Our understanding of disorders of consciousness has not kept pace with the advances in neurosurgical management that have decreased mortality following severe injury. There is still considerable confusion regarding differential diagnosis and prognostication concerning states of severely altered consciousness. The purpose of this article is to discuss the content and neural basis of consciousness and to review the terminology most often used to describe altered states of consciousness. The neurobehavioral criteria for differentiating among specific syndromes associated with severe alterations in consciousness are presented. Representative case studies are utilized to illustrate the characteristic clinical profiles of coma, vegetative state, persistent and permanent vegetative state, minimally conscious state, akinetic mutism, and locked-in syndrome. Areas of ambiguity and controversy are emphasized and future directions for research are suggested.

UI	MeSH Term	Description	Entries
D009422	Nervous System Diseases	Diseases of the central and peripheral nervous system. This includes disorders of the brain, spinal cord, cranial nerves, peripheral nerves, nerve roots, autonomic nervous system, neuromuscular junction, and muscle.	Neurologic Disorders,Nervous System Disorders,Neurological Disorders,Disease, Nervous System,Diseases, Nervous System,Disorder, Nervous System,Disorder, Neurologic,Disorder, Neurological,Disorders, Nervous System,Disorders, Neurologic,Disorders, Neurological,Nervous System Disease,Nervous System Disorder,Neurologic Disorder,Neurological Disorder
D011782	Quadriplegia	Severe or complete loss of motor function in all four limbs which may result from BRAIN DISEASES; SPINAL CORD DISEASES; PERIPHERAL NERVOUS SYSTEM DISEASES; NEUROMUSCULAR DISEASES; or rarely MUSCULAR DISEASES. The locked-in syndrome is characterized by quadriplegia in combination with cranial muscle paralysis. Consciousness is spared and the only retained voluntary motor activity may be limited eye movements. This condition is usually caused by a lesion in the upper BRAIN STEM which injures the descending cortico-spinal and cortico-bulbar tracts.	Quadriparesis,Spastic Quadriplegia,Tetraplegia,Flaccid Quadriplegia,Flaccid Tetraplegia,Paralysis, Spinal, Quadriplegic,Spastic Tetraplegia,Flaccid Quadriplegias,Flaccid Tetraplegias,Quadripareses,Quadriplegia, Flaccid,Quadriplegia, Spastic,Quadriplegias,Quadriplegias, Flaccid,Quadriplegias, Spastic,Spastic Quadriplegias,Spastic Tetraplegias,Tetraplegia, Flaccid,Tetraplegia, Spastic,Tetraplegias,Tetraplegias, Flaccid,Tetraplegias, Spastic
D003128	Coma	A profound state of unconsciousness associated with depressed cerebral activity from which the individual cannot be aroused. Coma generally occurs when there is dysfunction or injury involving both cerebral hemispheres or the brain stem RETICULAR FORMATION.	Comatose,Pseudocoma,Comas,Pseudocomas
D003244	Consciousness Disorders	Organic mental disorders in which there is impairment of the ability to maintain awareness of self and environment and to respond to environmental stimuli. Dysfunction of the cerebral hemispheres or brain stem RETICULAR FORMATION may result in this condition.	Consciousness, Level Altered,Disorder of Consciousness,Disorders of Consciousness,Semiconsciousness,Altered Level of Consciousness,Consciousness, Level Depressed,Depressed Level of Consciousness,Consciousness Disorder
D003937	Diagnosis, Differential	Determination of which one of two or more diseases or conditions a patient is suffering from by systematically comparing and contrasting results of diagnostic measures.	Diagnoses, Differential,Differential Diagnoses,Differential Diagnosis
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000405	Akinetic Mutism	A syndrome characterized by a silent and inert state without voluntary motor activity despite preserved sensorimotor pathways and vigilance. Bilateral FRONTAL LOBE dysfunction involving the anterior cingulate gyrus and related brain injuries are associated with this condition. This may result in impaired abilities to communicate and initiate motor activities. (From Adams et al., Principles of Neurology, 6th ed, p348; Fortschr Neurol Psychiatr 1995 Feb;63(2):59-67)	Mutism, Akinetic,Akinetic Autism,Coma Vigil,Coma Vigilans,Akinetic Mutisms,Autism, Akinetic,Vigil, Coma,Vigils, Coma
D018458	Persistent Vegetative State	Vegetative state refers to the neurocognitive status of individuals with severe brain damage, in whom physiologic functions (sleep-wake cycles, autonomic control, and breathing) persist, but awareness (including all cognitive function and emotion) is abolished.	Minimally Conscious State,Permanent Vegetative State,Post-Traumatic Vegetative State,Vegetative State, Persistent,PVS (Persistent Vegetative State),Persistent Unawareness State,Post-Comatose Unawareness State,Post-Traumatic Unawareness State,Postcomatose Unawareness State,Posttraumatic Unawareness State,Prolonged Post-Traumatic Unawareness,Transient Vegetative State,Vegetative State,Minimally Conscious States,PVSs (Persistent Vegetative State),Permanent Vegetative States,Persistent Unawareness States,Persistent Vegetative States,Post Comatose Unawareness State,Post Traumatic Unawareness State,Post Traumatic Vegetative State,Post-Comatose Unawareness States,Post-Traumatic Unawareness States,Post-Traumatic Unawareness, Prolonged,Post-Traumatic Unawarenesses, Prolonged,Post-Traumatic Vegetative States,Postcomatose Unawareness States,Posttraumatic Unawareness States,Prolonged Post Traumatic Unawareness,Prolonged Post-Traumatic Unawarenesses,State, Minimally Conscious,State, Permanent Vegetative,State, Persistent Unawareness,State, Persistent Vegetative,State, Post-Comatose Unawareness,State, Post-Traumatic Unawareness,State, Post-Traumatic Vegetative,State, Postcomatose Unawareness,State, Posttraumatic Unawareness,State, Transient Vegetative,State, Vegetative,States, Minimally Conscious,States, Permanent Vegetative,States, Persistent Unawareness,States, Persistent Vegetative,States, Post-Comatose Unawareness,States, Post-Traumatic Unawareness,States, Post-Traumatic Vegetative,States, Postcomatose Unawareness,States, Posttraumatic Unawareness,States, Transient Vegetative,States, Vegetative,Transient Vegetative States,Unawareness State, Persistent,Unawareness State, Post-Comatose,Unawareness State, Post-Traumatic,Unawareness State, Postcomatose,Unawareness State, Posttraumatic,Unawareness States, Persistent,Unawareness States, Post-Comatose,Unawareness States, Post-Traumatic,Unawareness States, Postcomatose,Unawareness States, Posttraumatic,Unawareness, Prolonged Post-Traumatic,Unawarenesses, Prolonged Post-Traumatic,Vegetative State, Permanent,Vegetative State, Post-Traumatic,Vegetative State, Transient,Vegetative States,Vegetative States, Permanent,Vegetative States, Persistent,Vegetative States, Post-Traumatic,Vegetative States, Transient