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[The comatose patient].

H P Mattle1

  • 1Neurologische Klinik und Poliklinik, Universität Bern, Inselspital, Bern. heinrich.mattle@insel.ch

Therapeutische Umschau. Revue Therapeutique
|July 8, 2005
PubMed
Summary
This summary is machine-generated.

Normal brain function, including the cerebral cortex and brainstem, is essential for consciousness. Lesions in these areas can cause coma, with specific reflexes helping to diagnose the cause and guide treatment.

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Area of Science:

  • Neuroscience
  • Neurology

Context:

  • Consciousness and wakefulness depend on the integrated function of the cerebral cortex and the midbrain reticular formation.
  • Structural or functional disruptions in these critical brain regions can lead to impaired consciousness and coma.

Purpose:

  • To elucidate the neuroanatomical basis of consciousness and coma.
  • To highlight the diagnostic utility of clinical signs in differentiating causes of coma.

Summary:

  • Normal consciousness relies on the cerebral cortex and ascending projections from the midbrain reticular formation.
  • Bilateral lesions or dysfunction in these areas impair consciousness, resulting in coma.
  • Clinical examination, including assessment of bodily posture and brainstem reflexes, aids in localizing lesions (brainstem vs. cerebral hemispheres).

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  • Brainstem reflexes are often preserved in coma resulting from bilateral hemispheric dysfunction (e.g., metabolic, anoxic, toxic coma).
  • Ancillary tests assist in specific diagnostic inquiries, and coma treatment is etiology-dependent.

    • Impact:

    • Provides a framework for understanding the neurobiological underpinnings of consciousness and coma.
    • Emphasizes the importance of clinical neurological examination in the initial assessment of comatose patients.
    • Informs diagnostic strategies and therapeutic approaches for patients with impaired consciousness.