Loading…

Coma

Coma is a state of unarousable unconsciousness due to dysfunction of the brain's ascending reticular activating system (ARAS), which is responsible for arousal and the maintenance of wakefulness. Anatomically and physiologically the ARAS has a redundancy of pathways and neurotransmitters; this...

Full description

Saved in:
Bibliographic Details
Published in:Annals of the New York Academy of Sciences 2009-03, Vol.1157 (1), p.32-47
Main Author: Young, G. Bryan
Format: Article
Language:English
Subjects:
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by cdi_FETCH-LOGICAL-c5041-ba97380087097828498535458407f78f5c059d06f723c47a54187578c3f853d33
cites cdi_FETCH-LOGICAL-c5041-ba97380087097828498535458407f78f5c059d06f723c47a54187578c3f853d33
container_end_page 47
container_issue 1
container_start_page 32
container_title Annals of the New York Academy of Sciences
container_volume 1157
creator Young, G. Bryan
description Coma is a state of unarousable unconsciousness due to dysfunction of the brain's ascending reticular activating system (ARAS), which is responsible for arousal and the maintenance of wakefulness. Anatomically and physiologically the ARAS has a redundancy of pathways and neurotransmitters; this may explain why coma is usually transient (seldom lasting more than 3 weeks). Emergence from coma is succeeded by outcomes ranging from the vegetative state to complete recovery, depending on the severity of damage to the cerebral cortex, the thalamus, and their integrated function. The clinical and laboratory assessments of the comatose patient are reviewed here, along with an analysis of how various conditions (structural brain lesions, metabolic and toxic disorders, trauma, infections, seizures, hypothermia, and hyperthermia) produce coma. Management issues include the determination of the cause and reversibility (prognosis) of neurological impairment, support of the patient, definitive treatment when possible, and the ethical considerations for those situations where marked disability is predicted with certainty.
doi_str_mv 10.1111/j.1749-6632.2009.04471.x
format article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_20548929</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>20548929</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5041-ba97380087097828498535458407f78f5c059d06f723c47a54187578c3f853d33</originalsourceid><addsrcrecordid>eNqNkNFKwzAUhoMobk5fQbzyrvWkSXqSKxlDpzCmoCJeHbIuhc7WzmbD7e1N1zFvzU0C-c6X_D9jVxxiHtbNIuYoTZSmIokTABODlMjjzRHrHy6OWR8AMdImET125v0CgCda4inrcSMUF0r22fGoruw5O8lt6d3Ffh-wt_u719FDNHkaP46GkyhTIHk0swaFBtAIBnVQGa2CRGkJmKPOVQbKzCHNMRGZRKsk16hQZyIP4FyIAbvuvMum_l47v6Kq8JkrS_vl6rWnBJQM3zUB1B2YNbX3jctp2RSVbbbEgdoGaEFtUGqDUtsA7RqgTRi93L-xnlVu_je4jxyA2w74KUq3_beYph_Dl905GKLOUPiV2xwMtvmkFAUqep-OaWLk1AB_JhC_sNFz1g</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>20548929</pqid></control><display><type>article</type><title>Coma</title><source>Wiley-Blackwell Read &amp; Publish Collection</source><creator>Young, G. Bryan</creator><creatorcontrib>Young, G. Bryan</creatorcontrib><description>Coma is a state of unarousable unconsciousness due to dysfunction of the brain's ascending reticular activating system (ARAS), which is responsible for arousal and the maintenance of wakefulness. Anatomically and physiologically the ARAS has a redundancy of pathways and neurotransmitters; this may explain why coma is usually transient (seldom lasting more than 3 weeks). Emergence from coma is succeeded by outcomes ranging from the vegetative state to complete recovery, depending on the severity of damage to the cerebral cortex, the thalamus, and their integrated function. The clinical and laboratory assessments of the comatose patient are reviewed here, along with an analysis of how various conditions (structural brain lesions, metabolic and toxic disorders, trauma, infections, seizures, hypothermia, and hyperthermia) produce coma. Management issues include the determination of the cause and reversibility (prognosis) of neurological impairment, support of the patient, definitive treatment when possible, and the ethical considerations for those situations where marked disability is predicted with certainty.</description><identifier>ISSN: 0077-8923</identifier><identifier>EISSN: 1749-6632</identifier><identifier>EISSN: 1930-6547</identifier><identifier>DOI: 10.1111/j.1749-6632.2009.04471.x</identifier><identifier>PMID: 19351354</identifier><language>eng</language><publisher>Malden, USA: Blackwell Publishing Inc</publisher><subject>ascending reticular activating system (ARAS) ; Brain Concussion - complications ; Brain Injuries - complications ; coma ; Coma - diagnosis ; Coma - etiology ; Coma - physiopathology ; Coma - therapy ; Diagnosis, Differential ; diffuse axonal injury (DAI) ; encephalopathies ; ethical management ; Fever - complications ; Humans ; Hypothermia - complications ; Infection - complications ; locked-in syndrome ; Wounds and Injuries - complications</subject><ispartof>Annals of the New York Academy of Sciences, 2009-03, Vol.1157 (1), p.32-47</ispartof><rights>2009 Association for Research in Nervous and Mental Disease</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5041-ba97380087097828498535458407f78f5c059d06f723c47a54187578c3f853d33</citedby><cites>FETCH-LOGICAL-c5041-ba97380087097828498535458407f78f5c059d06f723c47a54187578c3f853d33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19351354$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Young, G. Bryan</creatorcontrib><title>Coma</title><title>Annals of the New York Academy of Sciences</title><addtitle>Ann N Y Acad Sci</addtitle><description>Coma is a state of unarousable unconsciousness due to dysfunction of the brain's ascending reticular activating system (ARAS), which is responsible for arousal and the maintenance of wakefulness. Anatomically and physiologically the ARAS has a redundancy of pathways and neurotransmitters; this may explain why coma is usually transient (seldom lasting more than 3 weeks). Emergence from coma is succeeded by outcomes ranging from the vegetative state to complete recovery, depending on the severity of damage to the cerebral cortex, the thalamus, and their integrated function. The clinical and laboratory assessments of the comatose patient are reviewed here, along with an analysis of how various conditions (structural brain lesions, metabolic and toxic disorders, trauma, infections, seizures, hypothermia, and hyperthermia) produce coma. Management issues include the determination of the cause and reversibility (prognosis) of neurological impairment, support of the patient, definitive treatment when possible, and the ethical considerations for those situations where marked disability is predicted with certainty.</description><subject>ascending reticular activating system (ARAS)</subject><subject>Brain Concussion - complications</subject><subject>Brain Injuries - complications</subject><subject>coma</subject><subject>Coma - diagnosis</subject><subject>Coma - etiology</subject><subject>Coma - physiopathology</subject><subject>Coma - therapy</subject><subject>Diagnosis, Differential</subject><subject>diffuse axonal injury (DAI)</subject><subject>encephalopathies</subject><subject>ethical management</subject><subject>Fever - complications</subject><subject>Humans</subject><subject>Hypothermia - complications</subject><subject>Infection - complications</subject><subject>locked-in syndrome</subject><subject>Wounds and Injuries - complications</subject><issn>0077-8923</issn><issn>1749-6632</issn><issn>1930-6547</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><recordid>eNqNkNFKwzAUhoMobk5fQbzyrvWkSXqSKxlDpzCmoCJeHbIuhc7WzmbD7e1N1zFvzU0C-c6X_D9jVxxiHtbNIuYoTZSmIokTABODlMjjzRHrHy6OWR8AMdImET125v0CgCda4inrcSMUF0r22fGoruw5O8lt6d3Ffh-wt_u719FDNHkaP46GkyhTIHk0swaFBtAIBnVQGa2CRGkJmKPOVQbKzCHNMRGZRKsk16hQZyIP4FyIAbvuvMum_l47v6Kq8JkrS_vl6rWnBJQM3zUB1B2YNbX3jctp2RSVbbbEgdoGaEFtUGqDUtsA7RqgTRi93L-xnlVu_je4jxyA2w74KUq3_beYph_Dl905GKLOUPiV2xwMtvmkFAUqep-OaWLk1AB_JhC_sNFz1g</recordid><startdate>200903</startdate><enddate>200903</enddate><creator>Young, G. Bryan</creator><general>Blackwell Publishing Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope></search><sort><creationdate>200903</creationdate><title>Coma</title><author>Young, G. Bryan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5041-ba97380087097828498535458407f78f5c059d06f723c47a54187578c3f853d33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>ascending reticular activating system (ARAS)</topic><topic>Brain Concussion - complications</topic><topic>Brain Injuries - complications</topic><topic>coma</topic><topic>Coma - diagnosis</topic><topic>Coma - etiology</topic><topic>Coma - physiopathology</topic><topic>Coma - therapy</topic><topic>Diagnosis, Differential</topic><topic>diffuse axonal injury (DAI)</topic><topic>encephalopathies</topic><topic>ethical management</topic><topic>Fever - complications</topic><topic>Humans</topic><topic>Hypothermia - complications</topic><topic>Infection - complications</topic><topic>locked-in syndrome</topic><topic>Wounds and Injuries - complications</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Young, G. Bryan</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><jtitle>Annals of the New York Academy of Sciences</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Young, G. Bryan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Coma</atitle><jtitle>Annals of the New York Academy of Sciences</jtitle><addtitle>Ann N Y Acad Sci</addtitle><date>2009-03</date><risdate>2009</risdate><volume>1157</volume><issue>1</issue><spage>32</spage><epage>47</epage><pages>32-47</pages><issn>0077-8923</issn><eissn>1749-6632</eissn><eissn>1930-6547</eissn><abstract>Coma is a state of unarousable unconsciousness due to dysfunction of the brain's ascending reticular activating system (ARAS), which is responsible for arousal and the maintenance of wakefulness. Anatomically and physiologically the ARAS has a redundancy of pathways and neurotransmitters; this may explain why coma is usually transient (seldom lasting more than 3 weeks). Emergence from coma is succeeded by outcomes ranging from the vegetative state to complete recovery, depending on the severity of damage to the cerebral cortex, the thalamus, and their integrated function. The clinical and laboratory assessments of the comatose patient are reviewed here, along with an analysis of how various conditions (structural brain lesions, metabolic and toxic disorders, trauma, infections, seizures, hypothermia, and hyperthermia) produce coma. Management issues include the determination of the cause and reversibility (prognosis) of neurological impairment, support of the patient, definitive treatment when possible, and the ethical considerations for those situations where marked disability is predicted with certainty.</abstract><cop>Malden, USA</cop><pub>Blackwell Publishing Inc</pub><pmid>19351354</pmid><doi>10.1111/j.1749-6632.2009.04471.x</doi><tpages>16</tpages></addata></record>
fulltext fulltext
identifier ISSN: 0077-8923
ispartof Annals of the New York Academy of Sciences, 2009-03, Vol.1157 (1), p.32-47
issn 0077-8923
1749-6632
1930-6547
language eng
recordid cdi_proquest_miscellaneous_20548929
source Wiley-Blackwell Read & Publish Collection
subjects ascending reticular activating system (ARAS)
Brain Concussion - complications
Brain Injuries - complications
coma
Coma - diagnosis
Coma - etiology
Coma - physiopathology
Coma - therapy
Diagnosis, Differential
diffuse axonal injury (DAI)
encephalopathies
ethical management
Fever - complications
Humans
Hypothermia - complications
Infection - complications
locked-in syndrome
Wounds and Injuries - complications
title Coma
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-24T13%3A15%3A49IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Coma&rft.jtitle=Annals%20of%20the%20New%20York%20Academy%20of%20Sciences&rft.au=Young,%20G.%20Bryan&rft.date=2009-03&rft.volume=1157&rft.issue=1&rft.spage=32&rft.epage=47&rft.pages=32-47&rft.issn=0077-8923&rft.eissn=1749-6632&rft_id=info:doi/10.1111/j.1749-6632.2009.04471.x&rft_dat=%3Cproquest_cross%3E20548929%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c5041-ba97380087097828498535458407f78f5c059d06f723c47a54187578c3f853d33%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=20548929&rft_id=info:pmid/19351354&rfr_iscdi=true