离解(化学)
清醒
心理学
最小意识状态
认知
持续植物状态
神经科学
电动机系统
彗差(光学)
意识
意识障碍
物理医学与康复
认知心理学
听力学
脑电图
医学
化学
物理化学
物理
光学
作者
Karin Diserens,Ivo Meyer,Jane Jöhr,Alessandro Pincherle,Vincent Dunet,Polona Pozeg,Philippe Ryvlin,Dafin F. Mureșanu,Robert Stevens,Nicholas D. Schiff
出处
期刊:Neurology
[Ovid Technologies (Wolters Kluwer)]
日期:2023-06-13
卷期号:100 (24): 1144-1150
被引量:6
标识
DOI:10.1212/wnl.0000000000207067
摘要
Brain-injured patients in a state of cognitive motor dissociation (CMD) exhibit a lack of command following using conventional neurobehavioral examination tools but a high level of awareness and language processing when assessed using advanced imaging and electrophysiology techniques. Because of their behavioral unresponsiveness, patients with CMD may seem clinically indistinguishable from those with a true disorder of consciousness that affects awareness on a substantial level (coma, vegetative state/unresponsive wakefulness state, or minimally conscious state minus). Yet, by expanding the range of motor testing across limb, facial, and ocular motricity, we may detect subtle, purposeful movements even in the subset of patients classified as vegetative state/unresponsive wakefulness state. We propose the term of clinical CMD to describe patients showing these slight but determined motor responses and exhibiting a characteristic akinetic motor behavior as opposed to a pyramidal motor system behavior. These patients may harbor hidden cognitive capabilities and significant potential for a good long-term outcome. Indeed, we envision CMD as ranging from complete (no motor response) to partial (subtle clinical motor response) forms, falling within a spectrum of progressively better motor output in patients with considerable cognitive capabilities. In addition to providing a decisional flowchart, we present this novel approach to classification as a graphical model that illustrates the range of clinical manifestations and recovery trajectories fundamentally differentiating true disorders of consciousness from the spectrum of CMD.
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