Abstract
A follow up study is reported of 100 consecutive unconscious patients admitted to an intensive care coma facility with a history of 30 days or more of unconsciousness of nontraumatic cause. Twenty recovered consciousness, all within 5 months of injury. 31 of the remaining patients died within 6 months following injury, while 49 continued unconscious until death. The mean life expectancy of these 49 was 26-34 months from that time. All 20 patients who recovered awareness continued to suffer from major disability. The prognosis for life or death and for recovery or not of consciousness was not significantly correlated with age or aetiology of the vegetative state. Among those who recovered consciousness, the younger patients showed somewhat better results in three parameters of function: locomotion, ADL and day-placement, but not in cognition, behaviour or speech accuracy and fluency. The overall results for these nontraumatic patients with postcomatose unawareness are clearly worse than those for patients with a similar period of unconsciousness following craniocerebral trauma.
Full text
PDFSelected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bates D., Caronna J. J., Cartlidge N. E., Knill-Jones R. P., Levy D. E., Shaw D. A., Plum F. A prospective study of nontraumatic coma: methods and results in 310 patients. Ann Neurol. 1977 Sep;2(3):211–220. doi: 10.1002/ana.410020306. [DOI] [PubMed] [Google Scholar]
- Braakman R., Jennett W. B., Minderhoud J. M. Prognosis of the posttraumatic vegetative state. Acta Neurochir (Wien) 1988;95(1-2):49–52. doi: 10.1007/BF01793082. [DOI] [PubMed] [Google Scholar]
- Bricolo A., Turazzi S., Feriotti G. Prolonged posttraumatic unconsciousness: therapeutic assets and liabilities. J Neurosurg. 1980 May;52(5):625–634. doi: 10.3171/jns.1980.52.5.0625. [DOI] [PubMed] [Google Scholar]
- Bruce D. A., Schut L., Bruno L. A., Wood J. H., Sutton L. N. Outcome following severe head injuries in children. J Neurosurg. 1978 May;48(5):679–688. doi: 10.3171/jns.1978.48.5.0679. [DOI] [PubMed] [Google Scholar]
- Costeff H., Groswasser Z., Goldstein R. Long-term follow-up review of 31 children with severe closed head trauma. J Neurosurg. 1990 Nov;73(5):684–687. doi: 10.3171/jns.1990.73.5.0684. [DOI] [PubMed] [Google Scholar]
- Dougherty J. H., Jr, Rawlinson D. G., Levy D. E., Plum F. Hypoxic-ischemic brain injury and the vegetative state: clinical and neuropathologic correlation. Neurology. 1981 Aug;31(8):991–997. doi: 10.1212/wnl.31.8.991. [DOI] [PubMed] [Google Scholar]
- Facco E., Zuccarello M., Pittoni G., Zanardi L., Chiaranda M., Davia G., Giron G. P. Early outcome prediction in severe head injury: comparison between children and adults. Childs Nerv Syst. 1986;2(2):67–71. doi: 10.1007/BF00286223. [DOI] [PubMed] [Google Scholar]
- Groswasser Z., Cohen M., Costeff H. Rehabilitation outcome after anoxic brain damage. Arch Phys Med Rehabil. 1989 Mar;70(3):186–188. [PubMed] [Google Scholar]
- Groswasser Z., Sazbon L. Outcome in 134 patients with prolonged posttraumatic unawareness. Part 2: Functional outcome of 72 patients recovering consciousness. J Neurosurg. 1990 Jan;72(1):81–84. doi: 10.3171/jns.1990.72.1.0081. [DOI] [PubMed] [Google Scholar]
- Higashi K., Sakata Y., Hatano M., Abiko S., Ihara K., Katayama S., Wakuta Y., Okamura T., Ueda H., Zenke M. Epidemiological studies on patients with a persistent vegetative state. J Neurol Neurosurg Psychiatry. 1977 Sep;40(9):876–885. doi: 10.1136/jnnp.40.9.876. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kriel R. L., Krach L. E., Sheehan M. Pediatric closed head injury: outcome following prolonged unconsciousness. Arch Phys Med Rehabil. 1988 Sep;69(9):678–681. [PubMed] [Google Scholar]
- Levy D. E., Caronna J. J., Singer B. H., Lapinski R. H., Frydman H., Plum F. Predicting outcome from hypoxic-ischemic coma. JAMA. 1985 Mar 8;253(10):1420–1426. [PubMed] [Google Scholar]
- Levy D. E., Knill-Jones R. P., Plum F. The vegetative state and its prognosis following nontraumatic coma. Ann N Y Acad Sci. 1978 Nov 17;315:293–306. doi: 10.1111/j.1749-6632.1978.tb50347.x. [DOI] [PubMed] [Google Scholar]
- Luerssen T. G., Klauber M. R., Marshall L. F. Outcome from head injury related to patient's age. A longitudinal prospective study of adult and pediatric head injury. J Neurosurg. 1988 Mar;68(3):409–416. doi: 10.3171/jns.1988.68.3.0409. [DOI] [PubMed] [Google Scholar]
- Mahoney W. J., D'Souza B. J., Haller J. A., Rogers M. C., Epstein M. H., Freeman J. M. Long-term outcome of children with severe head trauma and prolonged coma. Pediatrics. 1983 May;71(5):756–762. [PubMed] [Google Scholar]
- Najenson T., Mendelson L., Schechter I., David C., Mintz N., Groswasser Z. Rehabilitation after severe head injury. Scand J Rehabil Med. 1974;6(1):5–14. [PubMed] [Google Scholar]
- STRICH S. J. Diffuse degeneration of the cerebral white matter in severe dementia following head injury. J Neurol Neurosurg Psychiatry. 1956 Aug;19(3):163–185. doi: 10.1136/jnnp.19.3.163. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sacco R. L., VanGool R., Mohr J. P., Hauser W. A. Nontraumatic coma. Glasgow coma score and coma etiology as predictors of 2-week outcome. Arch Neurol. 1990 Nov;47(11):1181–1184. doi: 10.1001/archneur.1990.00530110035013. [DOI] [PubMed] [Google Scholar]
- Sazbon L., Groswasser Z. Outcome in 134 patients with prolonged posttraumatic unawareness. Part 1: Parameters determining late recovery of consciousness. J Neurosurg. 1990 Jan;72(1):75–80. doi: 10.3171/jns.1990.72.1.0075. [DOI] [PubMed] [Google Scholar]
- Sazbon L., Groswasser Z. Prolonged coma, vegetative state, post-comatose unawareness: semantics or better understanding? Brain Inj. 1991 Jan-Mar;5(1):1–2. doi: 10.3109/02699059108998504. [DOI] [PubMed] [Google Scholar]
- Sazbon L., Groswasser Z. Time-related sequelae of TBI in patients with prolonged post-comatose unawareness (PC-U) state. Brain Inj. 1991 Jan-Mar;5(1):3–8. doi: 10.3109/02699059108998505. [DOI] [PubMed] [Google Scholar]
- Tweed W. A., Thomassen A., Wernberg M. Prognosis after cardiac arrest based on age and duration of coma. Can Med Assoc J. 1982 May 1;126(9):1058–1060. [PMC free article] [PubMed] [Google Scholar]
- Yarnell P. R. Neurological outcome of prolonged coma survivors of out-of-hospital cardiac arrest. Stroke. 1976 May-Jun;7(3):279–282. doi: 10.1161/01.str.7.3.279. [DOI] [PubMed] [Google Scholar]