彗差(光学)
重症监护医学
医学
脑功能
意识
持续植物状态
神经学
神经科学
心理学
精神科
最小意识状态
光学
物理
作者
Alejandro A. Rabinstein
出处
期刊:Continuum
[Ovid Technologies (Wolters Kluwer)]
日期:2018-12-01
卷期号:24 (6): 1708-1731
被引量:6
标识
DOI:10.1212/con.0000000000000666
摘要
This article discusses the diagnostic and therapeutic approach to patients who are comatose and reviews the current knowledge on prognosis from various causes of coma. This article also provides an overview of the principles for determination of brain death as well as advice on how to avoid common pitfalls.Technologic advances have refined our understanding of the physiology of consciousness and the spectrum of disorders of consciousness; they also promise to improve our prognostic accuracy. Yet the clinical principles for the evaluation and treatment of coma remain unaltered. The clinical standards for determination of death by neurologic criteria (ie, brain death) are also well established, although variabilities in local protocols and legal requirements remain a problem to be resolved.Effective evaluation of coma demands a systematic approach relying on clinical information to ensure rational use of laboratory and imaging tests. When the cause of coma is deemed irreversible in the setting of a catastrophic brain injury and no clinical evidence exists for brain and brainstem function, patients should be evaluated for the possibility of brain death by following the clinical criteria specified in the American Academy of Neurology guidelines.
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