Coma

· Name of Symptom/Sign: Coma [[Imagen:{{{Imagen}}}|190Px|centro|]] ICD-10 R40.2 ICD-O: {{{ICDO}}} ICD-9 780.01 OMIM {{{OMIM}}} Medline Plus {{{Medline Plus}}} eMedicina {{{eMedicineSubj}}}/{{{eMedicineTema}}} EnfermedadesDB {{{EnfermedadesDB}}} In medicine, a coma (from the Greek koma, meaning deep sleep) is a profound state of unconsciousness. A comatose patient cannot be awakened, fails to respond normally to pain or light, does not have sleep-wake cycles, and does not take voluntary actions. Coma may result from a variety of conditions, including intoxication, metabolic abnormalities, central nervous system diseases, acute neurologic injuries such as stroke, and hypoxia. It may also be deliberately induced by pharmaceutical agents in order to preserve higher brain function following another form of brain trauma. Contents 1 Contrasts to other conditions 2 Distinctive phases of coma 3 Outcome 4 Records 5 Diagnosis and treatment 6 Ver también 7 Referencias 8 External links Contrasts to other conditions Some conditions share characteristics with coma and must be ruled out in a differential diagnosis before coma is conclusively diagnosed. These include locked-in syndrome, akinetic mutism, and catatonic stupor. The difference between coma and stupor is that a patient with coma cannot give a suitable response to either noxious or verbal stimuli, whereas a patient in a stupor can give a crude response, such as screaming, to an unpleasant stimulus. Some psychiatric diseases appear similar to coma. Some forms of schizophrenia, catatonia, and extremely severe major depression are responsible for behaviour that appears comatose. Coma is also to be distinguished from the persistent vegetative state which may follow it. This is a condition in which the individual has lost cognitive neurological function and awareness of the environment but does have noncognitive function and a preserved sleep-wake cycle. Spontaneous movements may occur and the eyes may open in response to external stimuli, but the patient does not speak or obey commands. Patients in a vegetative state may appear somewhat normal and may occasionally grimace, cry, or laugh. Likewise, coma is not the same as brain death, which is the irreversible cessation of all brain activity. One can be in a coma but still exhibit spontaneous respiration; one who is brain-dead, by definition, cannot. Coma is different from sleep; sleep is always reversible. Distinctive phases of coma Within coma itself, there are several categories that describe the severity of impairment. Contrary to popular belief, a patient in a comatose state does not always lay still and quiet. They may talk, walk, and perform other functions that may sometimes appear to be conscious acts, yet are not. Two scales of measurement frequently used in TBI diagnosis to determine the phase of coma are the Glasgow Coma Scale and the Ranchos Los Amigos Scale. The GCS is a simple 15-point scale used by medical professionals to assess severity of neurologic trauma, and establish a prognosis. The RLAS is a more complex scale that describes up to eight separate levels of coma, and is often used in the first few weeks or months of coma while the patient is under closer observation, and when shifts between levels are more frequent. Outcome There are several levels of coma, through which patients may or may not progress. As coma deepens, responsiveness of the brain lessens, normal reflexes are lost, and the patient no longer responds to pain. The chances of recovery depend on the severity of the underlying cause. A deeper coma alone does not necessarily mean a slimmer chance of recovery, because some people in deep coma recover well while others in a so-called milder coma sometimes fail to improve. Lin of REAC is in this state. He doesn't know what is going on. The outcome for coma and vegetative state depends on the cause, ubicación, severity and extent of neurological damage: outcomes range from recovery to death. People may emerge from a coma with a combination of physical, intellectual and psychological difficulties that need special attention. Recovery usually occurs gradually, with patients acquiring more and more ability to respond. Some patients never progress beyond very basic responses, but many recover full awareness. Gaining consciousness again is not instant: in the first days, patients are only awake for a few minutes, and duration of time awake gradually increases. Comas generally last a few days to a few weeks, and rarely last more than 2 Para 5 semanas. After this time, some patients gradually come out of the coma, some progress to a vegetative state, and others die. Many patients who have gone into a vegetative state go on to regain a degree of awareness. Others may remain in a vegetative state for years or even decades. Predicted chances of recovery are variable due to different techniques used to measure the extent of neurological damage. All the predictions are statistical rates with some level of chance for recovery present: a person with a low chance of recovery may still awaken. Time is the best general predictor of a chance for recovery, with the chances for recovery after 4 months of brain damage induced coma being low (menos que 15%), and full recovery being very low. [1] [2] The most common cause of death for a person in a vegetative state is secondary infection such as pneumonia which can occur in patients who lie still for extended periods. Records According to the Guinness Book of Records, the longest period of time spent in a coma was by Elaine Esposito. She did not wake up after being anaesthetized for an appendectomy on August 6, 1941, when age 6. She died on November 25 1978 a la edad 43 años 357 Días, having been in a coma for 37 años 111 days. Diagnosis and treatment Diagnosis has the following steps: Medical History, Physical Exam & Neurological Evaluation, Eye Examination, Laboratory Tests, Imaging Studies (Connecticut,MRI), EEG. The Glasgow Coma Scale is used to quantify the severity of a coma. There are three components to the score: Eye opening response, Verbal response, and Motor response. The Rancho Los Amigos Scale is also used. In Germany, music therapy is used to attempt to arouse patients from coma.[cita necesaria] See also Cerebrovascular accidents Cerebrovascular disorders Conscoiusness disturbances Epileptic seizures Injuries Insulin shock injury Minimally conscious state Traumatic Brain Injury US National Institute of Neurological Disorders and Stroke References Medical aspects of the persistent vegetative state. (1994).): New England Journal of Medicine Vol 330(22) Jun 1994, 1572-1579.  Adams, J. H., graham, D. Yo., & Jennett, B. (2000). The neuropathology of the vegetative state after an acute brain insult: Cerebro: A Journal of Neurology Vol 123(7) Jul 2000, 1327-1338. Akimov, G. Un., Nasonkin, O. S., Semin, G. F., & Pashkovsky, E. V. (1983). Evoked potentials of the brain in comas of various etiologies: Zhurnal Nevropatologii i Psikhiatrii imeni S S Korsakova Vol 83(12) 1983, 1761-1765. Akimov, G. Un., Nasonkin, O. S., Semin, G. F., & Paskhovskii, E. V. (1985). Evoked potentials of the brain in comatose states of varied etiology: Soviet Neurology & Psiquiatría vol. 18(3) Fal 1985, 98-105. Aldridge, D. (1991). Creativity and consciousness: Music therapy in intensive care: The Arts in Psychotherapy Vol 18(4) 1991, 359-362. Alves, J., Santolaria, F., & Liso, P. (1975). Emergencies in internal medicine: General rules for action in coma situations: Revista de Medicina de la Universidad de Navarra Vol 19 1975, 83-95. Amantini, Un., Grippo, Un., Fossi, S., Cesaretti, C., Piccioli, Un., Peris, Un., et al. (2005). Prediction of 'awakening' and outcome in prolonged acute coma from severe traumatic brain injury: Evidence for validity of short latency SEPs: Neurofisiología Clínica Vol 116(1) Ene 2005, 229-235. Andrews, K. (2004). Medical decision making in the vegetative state: Withdrawal of nutrition and hydration: NeuroRehabilitation Vol 19(4) 2004, 299-304. Angelino, E., Miglioretti, M., & Zotti, Un. M. (2002). Agitation Vol 18(3) Sep 2004, 435-437. abrazos, S., Colantonio, Un., Santaguida, P. L., & Paton, T. (2005). Amantadine to enhance readiness for rehabilitation following severe traumatic brain injury: Brain Injury Vol 19(14) Dic 2005, 1197-1206. Isono, M., Wakabayashi, Y., Fujikim, M., Kamida, T., & Kobayashi, H. (2002). Sleep cycle in patients in a state of permanent unconsciousness: Brain Injury Vol 16(8) Ago 2002, 705-712. Ives, E. R. (1963). Mental aberrations in diabetic patients: Bulletin of the Los Angeles Neurological Society 28(4) 1963, 279-285. Iwasaki, M., Nakasato, N., Kanno, Un., Hatanaka, K., Nagamatsu, K.-i., Nagamine, Y., et al. (2001). Somatosensory evoked fields in comatose survivors after severe traumatic brain injury: Neurofisiología Clínica Vol 112(1) Ene 2001, 205-211. Jacobs, H. E., Muir, C. Un., & Cline, J. D. (1986). Family reactions to persistent vegetative state: Revista de rehabilitación de traumatismo craneal vol. 1(1) Estropear 1986, 55-62. Jaffe, Un. S., & Landau, W. M. (1993). Death after death: The presumption of informed consent for cardiopulmonary resuscitation: Ethical paradox and clinical conundrum: Neurología vol. 43(11) Nov 1993, 2173-2178. Jennett, B. (1995). Clinical and pathological features of vegetative survival. Nueva York, NY: Oxford University Press. Jennett, B. (2002). Review of The Vegetative State. Medical Facts, Ethical and Legal Dilemmas: Neuropsychological Rehabilitation Vol 12(5) Nov 2002, 479-481. Jodar, M., & Junque, C. (1992). Postraumatic dementia: Cortical deficits on Cerebro-Encephalo Trauma (CET) without focal lesions: Dos casos de estudio: Revista de Psicología General y Aplicada Vol 45(2) Apr 1992, 177-182. Johnson, D. Un., & Roethig-Johnston, K. (1988). Coma stimulation: A challenge to occupational therapy: British Journal of Occupational Therapy Vol 51(3) Estropear 1988, 88-90. Johnson, D. E. (1986). Withholding fluids and nutrition: Identifying the populations at risk: Issues in Law & Medicine Vol 2(3) Nov 1986, 189-201. Johnson, G. M. (1987). Hypnotic imagery and suggestion as an adjunctive treatment in a case of coma: American Journal of Clinical Hypnosis Vol 29(4) Apr 1987, 255-259. Johnstone, B., & Bouman, D. E. (1992). Anoxic encephalopathy: A case study of an eight-year-old male with no residual cognitive deficits: Revista Internacional de Neurociencia vol. 62(3-4) Feb 1992, 207-213. Jones, S. J., Pato, M. V., Sprague, L., Stokes, M., Munday, R., & Haque, N. (2000). Auditory evoked potentials to spectro-temporal modulation of complex tones in normal subjects and patients with severe brain injury: Cerebro: A Journal of Neurology Vol 123(5) Mayo 2000, 1007-1016. Jover, F., Cuadrado, J.-M., Andreu, L., & Merino, J. (2002). Reversible coma caused by risperidone-ritonavir interaction: Clinical Neuropharmacology Vol 25(5) Sep-Oct 2002, 251-253. Kalmar, K., & Giacino, J. T. (2005). The JFK Coma Recovery Scale--Revised: Neuropsychological Rehabilitation Vol 15(3-4) Navidad-septiembre 2005, 454-460. Khligh, R. M. (1994). Neuropsychological Vol 24(6) Dic 2004, 670-672. McCawley, Un., Shachnow, N. K., & Mandell, S. (1975). Survival in lithium intoxication, status epilepticus, and prolonged coma: New York State Journal of Medicine Vol 75(3) Feb 1975, 407-409. Mclean, S. Un. M. (2005). Permanent vegetative state: The legal position: Neuropsychological Rehabilitation Vol 15(3-4) Navidad-septiembre 2005, 237-250. McMahon, K. T. (2004). Catholic moral teaching, medically assisted nutrition and hydration and the vegetative state: NeuroRehabilitation Vol 19(4) 2004, 373-379. Meltzer, H. Y. (1973). Rigidity, hyperpyrexia and coma following fluphenazine enanthate: Psychopharmacologia Vol 29(4) 1973, 337-346. Menon, D. K., Owen, Un. M., & Pickard, J. D. (1999). Response from Menon, Owen and Pickard: Trends in Cognitive Sciences Vol 3(2) Feb 1999, 44-46. Merlo, F., & Lion, P. (1985). Study of the rapid EEG activity induced by midazolam: Investigación terapéutica actual vol. 38(5) Nov 1985, 798-807. Meyers, C. Un., Levin, H. S., Eisenberg, H. M., & Guinto, F. C. (1983). Early versus late lateral ventricular enlargement following closed head injury: Diario de Neurología, Neurocirugía & Psiquiatría vol. 46(12) Dic 1983, 1092-1097. Morel, K. (1993). Assessing patients emerging from coma: Morel Auditory Comprehension Test: Journal of Cognitive Rehabilitation Vol 11(6) Nov-Dic 1993, 32-36. Msall, M., & et al. (1984). Neurologic outcome in children with inborn errors of urea synthesis: Outcome of urea-cycle enzymopathies: New England Journal of Medicine Vol 310(23) Jun 1984, 1500-1505. Munday, R. (2005). Vegetative and minimally conscious states: How can occupational therapists help? : Neuropsychological Rehabilitation Vol 15(3-4) Navidad-septiembre 2005, 503-513. Mwaria, C. B. (1990). The concept of self in the context of crisis: A study of families of the severely brain-injured: Social Science & Medicine Vol 30(8) 1990, 889-893. Naccache, L., Puybasset, L., Gaillard, R., Servir, E., & Willer, J.-C. (2005). Auditory mismatch negativity is a good predictor of awakening in comatose patients: A fast and reliable procedure: Neurofisiología Clínica Vol 116(4) Apr 2005, 988-990. Nagler, K. L. (1990). Rehabilitation effectiveness for post coma patients with moderately severe closed head injury: A functional and social comparison: Resúmenes de disertación internacional. Najenson, T., & et al. (1978). Recovery of communicative functions after prolonged traumatic coma: Scandinavian Journal of Rehabilitation Medicine Vol 10(1) 1978, 15-21. Naude, K., & abrazos, M. (2005). Considerations for the use of assistive technology in patients with impaired states of consciousness: Neuropsychological Rehabilitation Vol 15(3-4) Navidad-septiembre 2005, 514-521. Nevins, M. Un. (1988). New Jersey's Supreme Court "deregulates" right-to-die cases: Revista de la Sociedad Americana de Geriatría Vol 36(5) Mayo 1988, 476-479. Nimz, M. M. (1986). Brophy v. New England Sinai Hospital: Issues in Law & Medicine Vol 2(3) Nov 1986, 221-234. Sin autoría, Yo. (2003). IX: Consciousness as a state: Waking, deep sleep, coma, anesthesia, and dreaming. Cambridge, MAMÁ: Prensa del MIT. Noel, G., & Meyers, C. (1971). Report of two cases of visual agnosia with achromatognosia: Acta Neurologica Belgica Vol 71(2) Estropear 1971, 173-184. Obrador, S., & et al. (1975). Comatose state maintained during eight years following a vascular ponto-mesencephalic lesion: Electroencefalografía & Neurofisiología Clínica Vol 38(1) Ene 1975, 21-26. Oder, W., Podreka, Yo., Spatt, J., & Goldenberg, G. (1995). Cerebral function following catastrophic brain injury: Relevance of single photon emission computed tomography and positron emission tomography. Nueva York, NY: Oxford University Press. Oksenberg, Un., Gordon, C., Arons, E., & Sazbon, L. (2001). Phasic activities of rapid eye movement sleep in vegetative state patients: Dormir: Journal of Sleep Research & Sleep Medicine Vol 24(6) Jun 2001, 703-706. Oppenheim-Gluckman, H. (1994). In the depths of coma, a subject? : Topique: Revue Freudienne Vol 24(55) 1994, 469-486. Oppenheim-Gluckman, H. (1995). Comas and ethics: Evolución psiquiátrica vol. 60(3) Navidad-septiembre 1995, 471-492. Osson, D. (1988). The rebuilding of identity after traumatic coma: Psychologie Medicale Vol 20(4) Estropear 1988, 553-556. Ottani, Un., Saltini, S., Bartiromo, M., Zaffe, D., Botticelli, Un. R., Ferrari, Un., et al. (2003). Effect of gamma -hydroxybutyrate in two rat models of focal cerebral damage: Investigación del cerebro vol. 986(1-2) Oct 2003, 181-190. Ottaviani, F., Almadori, G., Calderazzo, Un. B., Frenguelli, Un., & et al. (1986). Auditory brain-stem (ABRs) and middle latency auditory responses (MLRs) in the prognosis of severely head-injured patients: Electroencefalografía & Clinical Neurophysiology: Evoked Potentials Vol 65(3) Mayo 1986, 196-202. Owen, Un. M., Coleman, M. R., Boly, M., Davis, M. H., Laureys, S., & Pickard, J. D. (2007). Using functional magnetic resonance imaging to detect covert awareness in the vegetative state: Archivos de neurología vol. 64(8) Ago 2007, 1098-1102. Owen, Un. M., Coleman, M. R., Menon, D. K., Johnsrude, Yo. S., Rodd, J. M., Davis, M. H., et al. (2005). Residual auditory function in persistent vegetative state: A combined PET and fMRI study: Neuropsychological Rehabilitation Vol 15(3-4) Navidad-septiembre 2005, 290-306. Owen, Un. M., Menon, D. K., Johnsrude, Yo. S., Bor, D., Scott, S. K., Manly, T., et al. (2002). Detecting residual cognitive function in persistent vegetative state: Neurocase Vol 8(5) 2002, 394-403. Pandharipande, P. PAGS., Pun, B. T., Herr, D. L., Maze, M., Girard, T. D., Molinero, R. R., et al. (2007). Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: The mends randomized controlled trial: JAMA: Revista de la Asociación Médica Estadounidense vol. 298(22) Dic 2007, 2644-2653. Panisset, M., Saxton, J., & Boller, F. (1995). End-stage Alzheimer's disease: Glasgow Coma Scale and the neurologic examination: Archivos de neurología vol. 52(2) Feb 1995, 127-128. Pape, T. L.-B., Lundgren, S., Heinemann, Un. W., Guernon, Un., Giobbie-Hurder, Un., Wang, J., et al. (2006). Establishing a prognosis for functional outcome during coma recovery: Brain Injury Vol 20(7) Jun 2006, 743-758. Parissis, D., Mellidis, C., Boutis, Un., Apostolidis, K., Ignatiadis, M., Kiosses, V., et al. (2003). Neurological findings in a case of coma secondary to Datura stramonium poisoning: European Journal of Neurology Vol 10(6) Nov 2003, 745-746. Parkes, M. J. (1992). Fetal behavioural states: Sleep and wakefulness? : The Quarterly Journal of Experimental Psychology B: Comparative and Physiological Psychology Vol 44B(3-4) Apr 1992, 231-244. Patrick, P. D., Patrick, S. T., Poole, J. D., & Hostler, S. (2000). Evaluation and treatment of the vegetative and minimally conscious child: A single subject design: Behavioral Interventions Vol 15(3) Navidad-septiembre 2000, 225-242. Paul, P. J., II. (2004). Address of Pope John Paul II to the Participants in the International Congress on "Life-Sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas", Saturday, 20 Marzo 2004: NeuroRehabilitation Vol 19(4) 2004, 273-275. Paulus, S. M. (1986). Corbett v. D'Alessandro: Issues in Law & Medicine Vol 2(3) Nov 1986, 217-219. Paulus, S. M. (1986). Rasmussen v. Fleming: Issues in Law & Medicine Vol 2(3) Nov 1986, 211-216. Pazzaglia, PAGS., Franco, G., Franco, F., & Gaist, G. (1975). Clinical course and prognosis of acute post-traumatic coma: Diario de Neurología, Neurocirugía & Psiquiatría vol. 38(2) Feb 1975, 149-154. Peetoom, J. J., & Schulte, P. F. J. (2004). Flumazenil possibly efficacious in patients in a coma caused by clozapine in combination with benzodiazepines. A case study: Revista de psiquiatría vol. 46(3) 2004, 185-190. Pelco, L. E. (1986). Intellectual recovery after severe closed head injury in children and young adults: Resúmenes de disertación internacional. Peri, C. V., Shaffrey, M. E., Farace, E., Tonelero, E., Alves, W. M., Tonelero, J. B., et al. (2001). Pilot study of electrical stimulation on median nerve in comatose severe brain injured patients: 3-month outcome: Brain Injury Vol 15(10) Oct 2001, 903-910. Phillips, D. PAGS., Christenfeld, N., Glynn, L. M., & Steinberg, Un. (1999). The influence of medical and legal authorities on deaths facilitated by physicians: Suicide and Life-Threatening Behavior Vol 29(1) Spr 1999, 48-57. Pickard, J. D. (2005). Parte II: Functional imaging, electrophysiology and mechanical intervention: Neuropsychological Rehabilitation Vol 15(3-4) Navidad-septiembre 2005, 272-275. Pickard, J. D., Coleman, M. R., & Czosnyka, M. (2005). Hydrocephalus, ventriculomegaly and the vegetative state: Una reseña: Neuropsychological Rehabilitation Vol 15(3-4) Navidad-septiembre 2005, 224-236. Pilon, M., & Sullivan, S. J. (1996). Motor profile of patients in minimally responsive and persistent vegetative states: Brain Injury Vol 10(6) Jun 1996, 421-437. Pinkofsky, H. B., Manno, J. E., & lechuguilla, Un. (1996). Naloxone-reversible coma unrelated to opiate drugs: Annals of Clinical Psychiatry Vol 8(4) Dic 1996, 211-213. Popoviciu, L., & et al. (1972). Anatomoclinical and electropolygraphic investigations in prolonged coma in cerebral vascular diseases: Study of relationships between coma and consciousness disturbances: Neurologia, Psihiatria, Neurochirurgia Vol 17(4) Jul 1972, 333-346. Precio, W. Un., Zimmer, B., Conway, R., & Szekely, B. (1986). Insulin-induced factitious hypoglycemic coma: Hospital General de Psiquiatría Vol 8(4) Jul 1986, 291-293. Prior, M., Kinsella, G., Aserrador, M., bryan, D., & et al. (1994). Cognitive and psychosocial outcome after head injury in children: Australian Psychologist Vol 29(2) Jul 1994, 116-123. Province, C. (2005). The vegetative state: Promoting greater clarity and improved treatment: Neuropsychological Rehabilitation Vol 15(3-4) Navidad-septiembre 2005, 264-271. Pruneti, C. Un., Cantini, R., & Baracchini-Muratorio, G. (1988). Prognostic value of type of coma after serious head injury in childhood: Research Communications in Psychology, Psiquiatría & Comportamiento Vol 13(3) 1988, 193-217. Pruneti, C. Un., Cantini, R., & Baracchini-Muratorio, G. (1989). Behavioral treatment of children after severe head injury: A pilot study: Italian Journal of Neurological Sciences Vol 10(5) Oct 1989, 491-498. Pruneti, C. Un., Cocci, D., Marchionni, M., Rota, S., & et al. (1995). Application of the Luria-Nebraska Neuropsychological Battery in the functional analysis of subjects with head injury and subsequent coma: Giornale di Neuropsichiatria dell'Eta Evolutiva Vol 15(3) Sep 1995, 159-165. Pushkov, V. V., Kharitonov, R. Un., & Shchelkunov, E. L. (1980). Treatment of psychoses in children by means of cholinolytic comas: Trudy Leningradskogo Nauchno-Issledovatel'skogo Psikhonevrologicheskogo Instituta im V M Bekhtereva Vol 95 1980, 111-116. Quill, T. E. (2005). Terri Schiavo--A Tragedy Compounded: New England Journal of Medicine Vol 352(16) Apr 2005, 1630-1632. Rappaport, M. (1986). Brain evoked potentials in coma and the vegetative state: Revista de rehabilitación de traumatismo craneal vol. 1(1) Estropear 1986, 15-29. Rappaport, M. (2005). The Disability Rating and Coma/Near-Coma scales in evaluating severe head injury: Neuropsychological Rehabilitation Vol 15(3-4) Navidad-septiembre 2005, 442-453. Ratan, S. K., Pandey, R. M., & Ratan, J. (2001). Association among duration of unconsciousness, Glasgow Coma Scale, and cranial computed tomography abnormalities in head-injured children: Clinical Pediatrics Vol 40(7) Jul 2001, 375-378. Ratcliffe, P. J., & Bevan, J. S. (1985). Severe hypoglycaemia and sudden death in anorexia nervosa: Medicina Psicológica Vol. 15(3) Ago 1985, 679-681. Reminyak, V. Yo. (1982). Some characteristics of the metabolism of biogenic amines in schizophrenic patients treated by atropine comas: Zhurnal Nevropatologii i Psikhiatrii imeni S S Korsakova Vol 82(8) 1982, 1205-1212. Renella, C. (1998). Doing the right thing: Consequences for health care team members: Topics in Stroke Rehabilitation Vol 5(3) Fal 1998, 92-95. Rizzo, Un., & et al. (1976). CNV studies in subjects affected by cerebral lesions, traumatic and of different origins: Acta Neurologica Vol 31(3) Mayo-Junio 1976, 350-357. Robert, Un. (1985). Reconstruction after severe cranial trauma: Perspectives Psychiatriques Vol 23(5, No 104) 1985, 370-375. Rosadini, G., & Sannita, W. G. (1982). Inter- and intra-hemispheric topographic analyses of quantitative EEG in patients in coma: Research Communications in Psychology, Psiquiatría & Comportamiento Vol 7(1) 1982, 97-107. Rosin, Un. J. (1978). Very prolonged unresponsive state following brain injury: Scandinavian Journal of Rehabilitation Medicine Vol 10(1) 1978, 33-38. Rothstein, T. L., Tomás, E. M., & Sumi, S. M. (1991). Predicting outcome in hypoxic-ischemic coma: A prospective clinical and electrophysiologic study: Electroencefalografía & Neurofisiología Clínica Vol 79(2) Ago 1991, 101-107. Rumpl, E., & et al. (1983). Central somatosensory conduction time and short latency somatosensory evoked potentials in post-traumatic coma: Electroencefalografía & Neurofisiología Clínica Vol 56(6) Dic 1983, 583-596. Sachser, N., & Lick, C. (1989). Social stress in guinea pigs: Fisiología & Comportamiento Vol 46(2) Ago 1989, 137-144. Sadek, J., & Rockwood, K. (2003). Coma with accidental single dose of an atypical neuroleptic in a patient with Lewy body dementia: Revista americana de psiquiatría geriátrica vol. 11(1) ene-feb 2003, 112-113. Sadek, J., & Rockwood, K. (2003). Drs. Sadek and Rockwood reply: Revista americana de psiquiatría geriátrica vol. 11(3) Jun 2003, 380-381. Sailly, J. C. (1994). Economic aspects of the care of patients in the vegetative state: Acta Neurologica Belgica Vol 94(3) 1994, 155-165. Sakamoto, H. (2005). Caregivers' experience of process-oriented coma work: A phenomenological study. Resúmenes de disertación internacional: Sección B: Las Ciencias y la Ingeniería. Sarton-Debert, F., & Champanier, J. P. (1982). Mournings and impossible mourning for an adolescent: Neuropsiquiatría de la Infancia y la Adolescencia Vol. 30(12) Dic 1982, 709-714. Schiff, N. D., & Fins, J. J. (2007). Hope for "comatose" pacientes. Washington, DC: Prensa Dana. Schiff, N. D., & Plum, F. (1999). Cortical function in the persistent vegetative state: Trends in Cognitive Sciences Vol 3(2) Feb 1999, 43-44. Schnakers, C., Giacino, J., Kalmar, K., Piret, S., López, E., Boly, M., et al. (2006). Does the FOUR Score Correctly Diagnose the Vegetative and Minimally Conscious States? : Annals of Neurology Vol 60(6) Dic 2006, 744-745. Schnakers, C., Majerus, S., & Laureys, S. (2005). Bispectral analysis of electroencephalogram signals during recovery from coma: Conclusiones preliminares: Neuropsychological Rehabilitation Vol 15(3-4) Navidad-septiembre 2005, 381-388. Schoenle, P. W., & Witzke, W. (2004). How vegetative is the vegetative state? Preserved semantic processing in VS patients--Evidence from N 400 event-related potentials: NeuroRehabilitation Vol 19(4) 2004, 329-334. Schuri, U., & von Cramon, D. (1980). Autonomic and behavioral responses in coma due to drug overdose: Psicofisiología vol. 17(3) Mayo 1980, 253-258. vendedores, E. M., & Kalant, H. (1976). Drug therapy: Alcohol intoxication and withdrawal: New England Journal of Medicine Vol 294(14) Apr 1976, 757-762. Serafini, Un. (1993). Is coma morally equivalent to anencephalia? : Ética & Comportamiento Vol 3(2) 1993, 187-198. Serby, M., & samuels, S. C. (2003). Commentary on letter: Atypical antipsychotics and coma: Revista americana de psiquiatría geriátrica vol. 11(3) Jun 2003, 380. Settle, E. C. (1995). Valproic acid-associated encephalopathy with coma: Revista Americana de Psiquiatría Vol 152(8) Ago 1995, 1236-1237. Sgreccia, E. (2004). Vegetative state and brain death: Philosophical and ethical issues from a personalistic view: NeuroRehabilitation Vol 19(4) 2004, 361-366. Shakhnovich, Un. R., & Tomás, J. G. (1977). Micro-tremor of the eyes of comatose patients: Electroencefalografía & Neurofisiología Clínica Vol 42(1) Ene 1977, 117-119. Shewmon, D. Un. (2004). A critical analysis of conceptual domains of the vegetative state: Sorting fact from fancy: NeuroRehabilitation Vol 19(4) 2004, 343-347. Shiel, Un., wilson, B., Horn, S., watson, M., & et al. (1993). Can patients in coma following traumatic head injury learn simple tasks? : Neuropsychological Rehabilitation Vol 3(2) 1993, 161-175. Shiel, Un., & wilson, B. Un. (2005). Can behaviours observed in the early stages of recovery after traumatic brain injury predict poor outcome? : Neuropsychological Rehabilitation Vol 15(3-4) Navidad-septiembre 2005, 494-502. Shivji, Z. M., Streletz, L. J., Baeesa, S., & Girvin, J. (2003). Electrophysiological investigations in the locked-in syndrome: Un informe de caso: American Journal of Electroneurodiagnostic Technology Vol 43(2) Jun 2003, 60-69. Signorino, M., D'Acunto, S., Cercaci, S., & Pietropaoli, P. (1997). The P300 in traumatic coma: Conditioning of the odd-ball paradigm: Revista de psicofisiología vol. 11(1) 1997, 59-70. Cantante, J. (1997). One mother's story: Including her son in coma in a general education first-grade class. Baltimore, MD: Paul H Brookes Publishing. Sisler, G., & Penner, H. (1975). Amnesia following severe head injury: The Canadian Psychiatric Association Journal / La Revue de l'Association des psychiatres du Canada Vol 20(5) Ago 1975, 333-336. Slama, M., Masmoudi, K., Blanchard, N., & Andrejak, M. (2000). A possible case of lithium intoxication mimicking Creutzfeld-Jakob syndrome: Farmacopsiquiatría Vol. 33(4) Jul 2000, 145-146. Herrero, J. (1988). Hypoglycaemic coma associated with anorexia nervosa: Revista de psiquiatría de Australia y Nueva Zelanda, vol. 22(4) Dic 1988, 448-453. Smythies, J. (1999). The biochemical basis of coma: Psycoloquy Vol 10 Dic 1999, No Pagination Specified. Sonoo, M., Tsai-Shozawa, Y., Aoki, M., Nakatani, T., Hatanaka, Y., Mochizuki, Un., et al. (1999). N18 in median somatosensory evoked potentials: A new indicator of medullary function for the diagnosis of brain death: Diario de Neurología, Neurocirugía & Psiquiatría vol. 67(3) Sep 1999, 374-378. Sowunmi, Un. (1993). Psychosis after cerebral malaria in children: Journal of the National Medical Association Vol 85(9) Sep 1993, 695-696. Spittler, J. F. (1999). Disorders of consciousness: Fundamentals for an ethical assessment: avances en neurologia, Psiquiatría vol. 67(1) Ene 1999, 37-47. Spoljar, P. (2002). Psychic disorders in the coma awakening: Deficit or defense? : Annales Medico-Psychologiques Vol 160(9) Nov 2002, 633-639. Spoljar, P. (2007). The resurgence of the primal and "hallucinatory subsiding" in delirious forms of coma awakening: Annales Medico-Psychologiques Vol 165(4) Mayo 2007, 233-240. Stanczak, D. E. (1998). Methodological considerations in the neuropsychological study of central nervous system underarousal with a specific emphasis on coma: Neuropsychology Review Vol 8(4) Dic 1998, 191-201. Stockard, J. J., Werner, S. S., Aalbers, J. Un., & Chiappa, K. H. (1976). Electroencephalographic findings in phencyclidine intoxication: Archivos de neurología vol. 33(3) Estropear 1976, 200-203. Sutter, J. (1988). "The Things of Life": The familiar things in daily life: Psychologie Medicale Vol 20(4) Estropear 1988, 559-561. Synek, V. M., & Glasgow, G. L. (1985). Recovery from alpha coma after decompression sickness complicated by spinal cord lesions at cervical and midthoracic levels: Electroencefalografía & Neurofisiología Clínica Vol 60(5) Mayo 1985, 417-419. Talbot, L. R., & Whitaker, H. Un. (1994). Brain-injured persons in an altered state of consciousness: Measures and intervention strategies: Brain Injury Vol 8(8) Nov-Dic 1994, 689-699. Tamplin, J. (2000). Improvisational music therapy approaches to coma arousal: Australian Journal of Music Therapy Vol 11 2000, 38-51. valle del té, G., Knill-Jones, R., & Van der Sande, J. (1978). Observer variability in assessing impaired consciousness and coma: Diario de Neurología, Neurocirugía & Psiquiatría vol. 41(7) Jul 1978, 603-610. Thomke, F. (2006). EEG in sopor, coma and brain death: Das Neurophysiologie-Labor Vol 28(1) 2006, 13-22. Tiberi, E. (1993). Extrasomatic emotions: Journal of Near-Death Studies Vol 11(3) Spr 1993, 149-170. Tiberi, E. (1996). Hedonic deactivation: A new human value for an advanced society: Journal of Near-Death Studies Vol 15(1) Fal 1996, 55-69. Tomita, Y., Fukuda, C., Maegaki, Y., Hanaki, K., Kitagawa, K., & Sanpei, M. (2003). Re-evaluation of short latency somatosensory evoked potentials (P13, P14 and N18) for brainstem function in children who once suffered from deep coma: Cerebro & Development Vol 25(5) Ago 2003, 352-356. Triggs, W. J., Hueva, C. R., Rhead, W. J., Hanson, S. K., & et al. (1992). Neuropsychiatric manifestations of defect in mitochondrial beta oxidation response to riboflavin: Diario de Neurología, Neurocirugía & Psiquiatría vol. 55(3) Estropear 1992, 209-211. Tzidkiahu, T., Sazbon, L., & Solzi, P. (1994). Characteristic reactions of relatives of post-coma unawareness patients in the process of adjusting to loss: Brain Injury Vol 8(2) febrero-marzo 1994, 159-165. Uzan, M., Albayram, S., Dashti, S. G. R., Aydin, S., Hanci, M., & Kuday, C. (2003). Thalamic proton magnetic resonance spectroscopy in vegetative state induced by traumatic brain injury: Diario de Neurología, Neurocirugía & Psiquiatría vol. 74(1) Ene 2003, 33-37. Valente, M., Placidi, F., Oliveira, Un. J., Bigagli, Un., Morghen, Yo., Proietti, R., et al. (2002). Sleep organization pattern as a prognostic marker at the subacute stage of post-traumatic coma: Neurofisiología Clínica Vol 113(11) Nov 2002, 1798-1805. Van de Kelft, E., Candon, E., Couchet, PAGS., Frerebeau, PAGS., & et al. (1995). Early restructuration of consciousness after traumatic coma: Acta Neurologica Belgica Vol 95(2) 1995, 88-91. Vegar-Brozovic, V., & Bobic, J. (1990). The role of neuropsychological assessment of patients with head trauma after regaining consciousness from a coma: Primijenjena Psihologija Vol 11(2) Jun 1990, 107-111. Verhaeghe, S. T. L., van Zuuren, F. J., Defloor, T., Duijnstee, M. S. H., & Grypdonck, M. H. F. (2007). How does information influence hope in family members of traumatic coma patients in intensive care unit? : Journal of Clinical Nursing Vol 16(8) Ago 2007, 1488-1497. Verhaeghe, S. T. L., van Zuuren, F. J., Defloor, T., Duijnstee, M. S. H., & Grypdonck, M. H. F. (2007). The process and the meaning of hope for family members of traumatic coma patients in intensive care: Qualitative Health Research Vol 17(6) Jul 2007, 730-743. Vetter, P. H., & Proppe, D. G. (1992). Clozapine-induced coma: Revista de Enfermedades Nerviosas y Mentales Vol 180(1) Ene 1992, 58-59. Vieregge, PAGS., & Stuhlmann, W. (1987). Diabetic coma and Wernicke-Korsakoff's syndrome: Clinical importance of acquired thiamine deficiency: avances en neurologia, Psiquiatría vol. 55(4) Apr 1987, 130-139. ver por ejemplo, W. V., Rowe, W. T., David, J. J., Buckman, J., & et al. (1985). Possible ameliorating effect of captopril treatment and hyperosmolar coma in a patient with psychosis, intermittent hyponatremia, and polydipsia: Psychiatric Hospital Vol 16(4) Fal 1985, 183-186. Vignaendra, V., Wilkus, R. J., Copass, M. K., & Chatrian, G. E. (1974). Electroencephalographic rhythms of alpha frequency in comatose patients after cardiopulmonary arrest: Neurología vol. 24(6) Jun 1974, 582-588. Vikhlyaev, Y. Yo., & et al. (1979). Effect of piracetam on some aspects of the action produced by ethanol and acetaldehyde: Farmakologiya i Toksikologiya Vol 42(1) ene-feb 1979, 76-81. Vilkki, J., Poropudas, K., & Servo, Un. (1988). Memory disorder related to coma duration after head injury: Diario de Neurología, Neurocirugía & Psiquiatría vol. 51(11) Nov 1988, 1452-1454. Vicente, J.-L. (1994). Estado vegetativo persistente: Ethical aspects: Acta Neurologica Belgica Vol 94(3) 1994, 170-173. Wake, Y., Yamada, N., Onishi, M., Kuroda, S., & Kishimoto, Y. (2004). Coma and Mydriasis Associated with Probable Serotonin Syndrome: Seishin Igaku (Clinical Psychiatry) Para. 46(3) Estropear 2004, 291-293. Caminante, M. C. (2001). Diagnosis and treatment of nonconvulsive status epilepticus: Medicamentos del SNC Vol 15(12) 2001, 931-939. Wandzel, L. (1986). A case of drug-dependence treated with atropine coma: Psiquiatría polaca vol. 20(4) Navidad-agosto 1986, 312-313. Wandzel, L., & Falicki, Z. (1987). Heroin addiction treated by atropine coma: Revista Americana de Psiquiatría Vol 144(9) Sep 1987, 1243. Wang, J. T., Joven, G. B., & Connolly, J. F. (2004). Prognostic Value of Evoked Responses and Event-Related Brain Potentials in Coma: Canadian Journal of Neurological Sciences Vol 31(4) Nov 2004, 438-450. Conejera, H. C. (1895). Hibernation and Allied States in Animals: Psychological Review Vol 2(4) Jul 1895, 416. Westmoreland, B. F., Klass, D. W., Sharbrough, F. W., & Reagan, T. J. (1975). Alpha-coma: Electroencephalographic, clinical, pathologic, and etiologic correlations: Archivos de neurología vol. 32(11) Nov 1975, 713-718. Wettach, G. E. (2000). The near death experience as a product of isolated subcortical brain function: Journal of Near-Death Studies Vol 19(2) Victoria 2000, 71-90. Whyte, J., & Glenn, M. B. (1986). The care and rehabilitation of the patient in a persistent vegetative state: Revista de rehabilitación de traumatismo craneal vol. 1(1) Estropear 1986, 39-53. Wick, E. (2001). Hearing the unspoken: From hypnotherapist to comatherapist. Mahwah, NJ: Editores asociados de Lawrence Erlbaum. Wiese, M. F. (2003). British hospitals and different versions of the Glasgow coma scale: Telephone survey: BMJ: British Medical Journal Vol 327(7418) Oct 2003, 782-783. Wijdicks, E. F. M. (1996). Temporomandibular joint compression in coma: Neurología vol. 46(6) Jun 1996, 1774. Wijdicks, E. F. M., Bamlet, W. R., Maramattom, B. V., Manno, E. M., & McClelland, R. L. (2005). Validation of a New Coma Scale: The FOUR Score: Annals of Neurology Vol 58(4) Oct 2005, 585-593. Wijdicks, E. F. M., Bamlet, W. R., Maramattom, B. V., Manno, E. M., & McClelland, R. L. (2006). Does the FOUR Score Correctly Diagnose the Vegetative and Minimally Conscious States?: Reply: Annals of Neurology Vol 60(6) Dic 2006, 745. wilson, B. Un. (2005). Part III: Behavioural assessment and rehabilitation techniques: Neuropsychological Rehabilitation Vol 15(3-4) Navidad-septiembre 2005, 428-430. wilson, F. C., graham, L. E., & watson, T. (2005). Vegetative and minimally conscious states: Serial assessment approaches in diagnosis and management: Neuropsychological Rehabilitation Vol 15(3-4) Navidad-septiembre 2005, 431-441. wilson, F. C., Harpur, J., watson, T., & Morrow, J. Yo. (2002). Vegetative state and minimally responsive patients -- Regional survey, long-term case outcomes and service recommendations: NeuroRehabilitation Vol 17(3) 2002, 231-236. wilson, J. T. L., valle del té, G. M., Hadley, D. M., Wiedmann, K. D., & et al. (1994). Post-traumatic amnesia: Still a valuable yardstick: Diario de Neurología, Neurocirugía & Psiquiatría vol. 57(2) Feb 1994, 198-201. wilson, S. L., brock, D., Powell, G. E., Thwaites, H., & Elliott, K. (1996). Constructing arousal profiles for vegetative state patients--a preliminary report: Brain Injury Vol 10(2) febrero-marzo 1996, 105-113. wilson, S. L., Cranny, S. M., & Andrews, K. (1992). The efficacy of music for stimulation in prolonged coma: Four single case experiments: Clinical Rehabilitation Vol 6(3) 1992, 181-187. wilson, S. L., & Mc Millan, T. M. (1993). A review of the evidence for the effectiveness of sensory stimulation treatment for coma and vegetative states: Neuropsychological Rehabilitation Vol 3(2) 1993, 149-160. wilson, S. L., Powell, G. E., brock, D., & Thwaites, H. (1996). Behavioural differences between patients who emerged from vegetative state and those who did not: Brain Injury Vol 10(7) Jul 1996, 509-516. wilson, S. L., Powell, G. E., eliot, K., & Thwaites, H. (1993). Evaluation of sensory stimulation as a treatment for prolonged coma: Seven single experimental case studies: Neuropsychological Rehabilitation Vol 3(2) 1993, 191-201. Wong, P. PAGS., Monette, G., & Weiner, N. Yo. (2001). Mathematical models of cognitive recovery: Brain Injury Vol 15(6) Jun 2001, 519-530. Madera, R. L., Winkowski, T. B., Molinero, J. L., Tierney, L., & et al. (1992). Evaluating sensory regulation as a method to improve awareness in patients with altered states of consciousness: A pilot study: Brain Injury Vol 6(5) Sep-Oct 1992, 411-418. Yamada, T., Fatigar, R. PAGS., & Kooi, K. Un. (1976). Fourteen and six c/sec positive bursts in comatose patients: Electroencefalografía & Neurofisiología Clínica Vol 40(6) Jun 1976, 645-653. Yamamoto, T., & Katayama, Y. (2005). Deep brain stimulation therapy for the vegetative state: Neuropsychological Rehabilitation Vol 15(3-4) Navidad-septiembre 2005, 406-413. Joven, G. B., Leung, L. S., Campbell, V., DeMelo, J., & et al. (1992). The electroencephalogram in metabolic/toxic coma: American Journal of EEG Technology Vol 32(4) Dic 1992, 243-259. Zandbergen, E. G. J., Hijdra, Un., Koelman, J. H. T. M., Ciervo, Un. Un. M., Vos, P. E., Verbeek, M. M., et al. (2006). Prediction of poor outcome within the first 3 days of postanoxic coma: Neurología vol. 66(1) Ene 2006, 62-68. Zandbergen, E. G. J., Koelman, J. H. T. M., de Haan, R. J., & Hijdra, Un. (2006). SSEPs and prognosis in postanoxic coma: Only short or also long latency responses? : Neurología vol. 67(4) Ago 2006, 583-586. Zandbergen, E. G. L., Koelman, J. H. T. M., de Haan, R. J., & Hijdra, Un. (2007). "SSEPs and prognosis in postanoxic coma: Only short or also long latency responses?": Reply: Neurología vol. 68(11) Estropear 2007, 877. zevin, S., & Hershko, C. (1991). Reversible flaccid paralysis and myxedema coma associated with lithium therapy: Lithium Vol 2(4) Nov 1991, 247-248. Zucker, Un. (2004). Law and ethics: Death Studies Vol 28(2) febrero-marzo 2004, 181-184. Zucker, Un., & Annarino, L. (1986). Department of law and ethics: Death Studies Vol 10(4) 1986, 365-369.  External links Waiting.com - support group for coma patients' families Brain Injury Fact Sheets - Information on coma, and many other effects of brain injury. TBI Resource Guide Central source of information, services and products relating to brain injury, brain injury recovery, and post-acute rehabilitation. Brain Injury Association of America (BIAUSA). Types of Brain Injury. This article contains text from the NINDS public domain pages on TBI Some of the information in this section is from the public domain resource provided by the National Institute of Neurological Diseases and Stroke. Esta página utiliza contenido con licencia Creative Commons de Wikipedia (ver autores).