Prolonged posttraumatic unconsciousness

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  • 1 Department of Neurosurgery, City Hospital, Verona, Italy
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✓ Prolonged coma following severe head injury is a serious condition because it implies a poor prognosis. In order to assess the magnitude of this phenomenon, the authors have reviewed 135 cases of posttraumatic unconsciousness lasting more than 2 weeks, from among the entire propulation of patients with severe head injury managed in 10 years in their neurosurgical intensive care unit. The incidence of prolonged coma was 4% of all patients with acute traumatic coma, and 0.6% of all hospitalized patients with head injury. By 1 year after trauma, 30% of the patients had died, 8% survived in a vegetative state, 31% survived with severe disabilities, and 31% had made a satisfactory recovery. The early clinical picture of prolonged unconsciousness has no predictive value as to further evolution. Patients emerge from unconsciousness in consecutive steps representing the restoration of increasingly complex neurological functions; the timing of these steps is very variable and sometimes covers several months. The time distribution of recovery steps in individual cases is of limited predictive value as to outcome. The most frequent state during the recovery process is the condition of wakefulness without awareness, which should not be pronounced “permanent” earlier than 1 year after injury.

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Contributor Notes

Address reprint requests to: Albino Bricolo, M.D., Department of Neurosurgery, City Hospital, Verona 37100, Italy.
  • 1.

    Adams H, , Mitchell DE, & Graham DI, et al: Diffuse brain damage of immediate impact type. Its relationship to “primary brain-stem damage” in head injury. Brain 100:489502, 1977 Adams H, Mitchell DE, Graham DI, et al: Diffuse brain damage of immediate impact type. Its relationship to “primary brain-stem damage” in head injury. Brain 100:489–502, 1977

    • Search Google Scholar
    • Export Citation
  • 2.

    Alajouanine T: Les alterations des états de conscience causées par les désordres neurologiques. Acta Med Belg 2:1941, 1957 Alajouanine T: Les alterations des états de conscience causées par les désordres neurologiques. Acta Med Belg 2:19–41, 1957

    • Search Google Scholar
    • Export Citation
  • 3.

    Bates D, , Caronna JJ, & Cartlidge NEF, et al: A prospective study of nontraumatic coma: methods and results in 310 patients. Ann Neurol 2:211220, 1977 Bates D, Caronna JJ, Cartlidge NEF, et al: A prospective study of nontraumatic coma: methods and results in 310 patients. Ann Neurol 2:211–220, 1977

    • Search Google Scholar
    • Export Citation
  • 4.

    Becker DP, , Miller JD, & Ward JD, et al: The outcome from severe head injury with early diagnosis and intensive management. J Neurosurg 47:491502, 1977 Becker DP, Miller JD, Ward JD, et al: The outcome from severe head injury with early diagnosis and intensive management. J Neurosurg 47:491–502, 1977

    • Search Google Scholar
    • Export Citation
  • 5.

    Bergamasco B, , Bergamini L, & Bricolo A, et al: Studies on sleep during the apallic syndrome, in Dalle Ore G, , Gerstenbrand F, & Lücking CH, et al (eds): The Apallic Syndrome. Berlin/Heidelberg/New York: Springer-Verlag, 1977, pp 155159 Bergamasco B, Bergamini L, Bricolo A, et al: Studies on sleep during the apallic syndrome, in Dalle Ore G, Gerstenbrand F, Lücking CH, et al (eds): The Apallic Syndrome. Berlin/Heidelberg/New York: Springer-Verlag, 1977, pp 155–159

    • Search Google Scholar
    • Export Citation
  • 6.

    Bricolo A: Prolonged post-traumatic coma, in Vinken PJ, & Bruyn GW (eds): Handbook of Clinical Neurology. Amsterdam: North-Holland, 1976, Vol 24, pp 699755 Bricolo A: Prolonged post-traumatic coma, in Vinken PJ, Bruyn GW (eds): Handbook of Clinical Neurology. Amsterdam: North-Holland, 1976, Vol 24, pp 699–755

    • Search Google Scholar
    • Export Citation
  • 7.

    Bricolo A, , Battistini N, & Bergamini L, et al: A proposal for the clinical classification of acute coma due to organic cerebral lesions. J Neurosurg Sci 19:113119, 1975 Bricolo A, Battistini N, Bergamini L, et al: A proposal for the clinical classification of acute coma due to organic cerebral lesions. J Neurosurg Sci 19:113–119, 1975

    • Search Google Scholar
    • Export Citation
  • 8.

    Bricolo A, & Dolce G: Evoluzioni cliniche del coma postraumatico grave. Minerva Neurochir 13:6168, 1969 Bricolo A, Dolce G: Evoluzioni cliniche del coma postraumatico grave. Minerva Neurochir 13:61–68, 1969

    • Search Google Scholar
    • Export Citation
  • 9.

    Bricolo A, , Gentilomo A, & Rosadini G, et al: Long lasting post-traumatic unconsciousness. A study based on nocturnal EEG and polygraphic recordings. Acta Neurol Scand 44:512532, 1968 Bricolo A, Gentilomo A, Rosadini G, et al: Long lasting post-traumatic unconsciousness. A study based on nocturnal EEG and polygraphic recordings. Acta Neurol Scand 44:512–532, 1968

    • Search Google Scholar
    • Export Citation
  • 10.

    Bruce DA, , Schut L, & Bruno LA, et al: Outcome following severe head injuries in children. J Neurosurg 48:679688, 1978 Bruce DA, Schut L, Bruno LA, et al: Outcome following severe head injuries in children. J Neurosurg 48:679–688, 1978

    • Search Google Scholar
    • Export Citation
  • 11.

    Cairns H, , Oldfield RC, & Pennybacker JB, et al: Akinetic mutism with an epidermoid cyst of the 3rd ventricle. Brain 64:273290, 1941 Cairns H, Oldfield RC, Pennybacker JB, et al: Akinetic mutism with an epidermoid cyst of the 3rd ventricle. Brain 64:273–290, 1941

    • Search Google Scholar
    • Export Citation
  • 12.

    Carlsson C-A, , von Essen C, & Löfgren J: Factors affecting the clinical course of patients with severe head injuries. Part 1: Influence of biological factors. Part 2: Significance of posttraumatic coma. J Neurosurg 29:242251, 1968 Carlsson C-A, von Essen C, Löfgren J: Factors affecting the clinical course of patients with severe head injuries. Part 1: Influence of biological factors. Part 2: Significance of posttraumatic coma. J Neurosurg 29:242–251, 1968

    • Search Google Scholar
    • Export Citation
  • 13.

    Caronna JJ, & Plum F: Prognosis and medical coma, in McLaurin R (ed): Head Injuries. New York/San Francisco/London: Grune and Stratton, 1976, pp 39 Caronna JJ, Plum F: Prognosis and medical coma, in McLaurin R (ed): Head Injuries. New York/San Francisco/London: Grune and Stratton, 1976, pp 3–9

    • Search Google Scholar
    • Export Citation
  • 14.

    Crompton MR, , Teare RD, & Bowen DAL: Prolonged coma after head injury. Lancet 2:938940, 1966 Crompton MR, Teare RD, Bowen DAL: Prolonged coma after head injury. Lancet 2:938–940, 1966

    • Search Google Scholar
    • Export Citation
  • 15.

    Cullen DJ, , Ferrara LC, & Briggs BA, et al: Survival, hospitalization charges and follow-up results in critically ill patients. N Engl J Med 294:982987, 1976 Cullen DJ, Ferrara LC, Briggs BA, et al: Survival, hospitalization charges and follow-up results in critically ill patients. N Engl J Med 294:982–987, 1976

    • Search Google Scholar
    • Export Citation
  • 16.

    Dalle Ore G, , Gerstenbrand F, & Lückling CH, et al: The Apallic Syndrome. Berlin/Heidelberg/New York: Springer-Verlag, 1977, 295 pp Dalle Ore G, Gerstenbrand F, Lückling CH, et al: The Apallic Syndrome. Berlin/Heidelberg/New York: Springer-Verlag, 1977, 295 pp

    • Search Google Scholar
    • Export Citation
  • 17.

    Fischgold H: Inconscience et insomnie prolongés. Rev Neurol 94:816818, 1956 Fischgold H: Inconscience et insomnie prolongés. Rev Neurol 94:816–818, 1956

    • Search Google Scholar
    • Export Citation
  • 18.

    Fischgold H, & Mathis P: Obnubilations, Comas et Stupeurs. Paris: Masson, 1959, p 124 Fischgold H, Mathis P: Obnubilations, Comas et Stupeurs. Paris: Masson, 1959, p 124

    • Search Google Scholar
    • Export Citation
  • 19.

    Gerstenbrand F: The course of restitution of brain injury in the early and late stages and the rehabilitation measures. Scand J Rehabil Med 4:8589, 1972 Gerstenbrand F: The course of restitution of brain injury in the early and late stages and the rehabilitation measures. Scand J Rehabil Med 4:85–89, 1972

    • Search Google Scholar
    • Export Citation
  • 20.

    Gerstenbrand F: Das Traumatische Apallische Syndrom. Klinik, Morphologie, Pathophysiologie und Behandlung. Wien/New York: Springer-Verlag, 1967, p 344 Gerstenbrand F: Das Traumatische Apallische Syndrom. Klinik, Morphologie, Pathophysiologie und Behandlung. Wien/New York: Springer-Verlag, 1967, p 344

    • Search Google Scholar
    • Export Citation
  • 21.

    Gerstenbrand F: Neurologische Rehabilitation traumatischer Hirnschäden. Wien Med Wochenschr 118:782786, 1968 Gerstenbrand F: Neurologische Rehabilitation traumatischer Hirnschäden. Wien Med Wochenschr 118:782–786, 1968

    • Search Google Scholar
    • Export Citation
  • 22.

    Hiatt HH: Protecting the medical commons: who is responsible? N Engl J Med 293:235241, 1975 Hiatt HH: Protecting the medical commons: who is responsible? N Engl J Med 293:235–241, 1975

    • Search Google Scholar
    • Export Citation
  • 23.

    Higashi K, , Sakata Y, & Hatano M, et al: Epidemiological studies on patients with a persistent vegetative state. J Neurol Neurosurg Psychiatry 40:876885, 1977 Higashi K, Sakata Y, Hatano M, et al: Epidemiological studies on patients with a persistent vegetative state. J Neurol Neurosurg Psychiatry 40:876–885, 1977

    • Search Google Scholar
    • Export Citation
  • 24.

    Jacobson SA: Protracted unconsciousness due to closed head injury. Neurology 6:281287, 1956 Jacobson SA: Protracted unconsciousness due to closed head injury. Neurology 6:281–287, 1956

    • Search Google Scholar
    • Export Citation
  • 25.

    Jennett B: Prognosis of severe head injury in McLaurin R (ed): Head Injuries. New York/San Francisco/London: Grune and Stratton, 1976, pp 4547 Jennett B: Prognosis of severe head injury in McLaurin R (ed): Head Injuries. New York/San Francisco/London: Grune and Stratton, 1976, pp 45–47

    • Search Google Scholar
    • Export Citation
  • 26.

    Jennett B: Resource allocation for the severely brain damaged. Arch Neurol 33:595597, 1976 Jennett B: Resource allocation for the severely brain damaged. Arch Neurol 33:595–597, 1976

    • Search Google Scholar
    • Export Citation
  • 27.

    Jennett B: Scale, scope and philosophy of the clinical problem, in: Outcome of Severe Damage to the Central Nervous System. Ciba Foundation Series, Volume 34.Amsterdam: Elsevier, 1975, pp 321 Jennett B: Scale, scope and philosophy of the clinical problem, in: Outcome of Severe Damage to the Central Nervous System. Ciba Foundation Series, Volume 34. Amsterdam: Elsevier, 1975, pp 3–21

    • Search Google Scholar
    • Export Citation
  • 28.

    Jennett B: Some aspects of prognosis after severe head injury. Scand J Rehabil Med 4:1620, 1972 Jennett B: Some aspects of prognosis after severe head injury. Scand J Rehabil Med 4:16–20, 1972

    • Search Google Scholar
    • Export Citation
  • 29.

    Jennett B, & Bond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480484, 1975 Jennett B, Bond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480–484, 1975

    • Search Google Scholar
    • Export Citation
  • 30.

    Jennett B, & Plum F: Persistent vegetative state after brain damage. A syndrome in search of a name. Lancet 1:734737, 1972 Jennett B, Plum F: Persistent vegetative state after brain damage. A syndrome in search of a name. Lancet 1:734–737, 1972

    • Search Google Scholar
    • Export Citation
  • 31.

    Jennett B, , Teasdale G, & Braakman R, et al: Predicting outcome in individual patients after severe head injury. Lancet 1:10311034, 1976 Jennett B, Teasdale G, Braakman R, et al: Predicting outcome in individual patients after severe head injury. Lancet 1:1031–1034, 1976

    • Search Google Scholar
    • Export Citation
  • 32.

    Jennett B, , Teasdale G, & Galbraith S, et al: Severe head injuries in three countries. J Neurol Neurosurg Psychiatry 40:291298, 1977 Jennett B, Teasdale G, Galbraith S, et al: Severe head injuries in three countries. J Neurol Neurosurg Psychiatry 40:291–298, 1977

    • Search Google Scholar
    • Export Citation
  • 33.

    Jouvet M: Etude neurophysiologique clinique des troubles de la conscience. Acta Neurochir 12:258269, 1964 Jouvet M: Etude neurophysiologique clinique des troubles de la conscience. Acta Neurochir 12:258–269, 1964

    • Search Google Scholar
    • Export Citation
  • 34.

    Kretschmer E: Das apallische Syndrom. Z Gesamte Neurol Psychiatr 169:576579, 1940 Kretschmer E: Das apallische Syndrom. Z Gesamte Neurol Psychiatr 169:576–579, 1940

    • Search Google Scholar
    • Export Citation
  • 35.

    Lambooy N, , van der Zwan A, & Fossen A: End-results after long-term unconsciousness due to head-injury. Psychiatr Neurol Neurochir 68:431442, 1965 Lambooy N, van der Zwan A, Fossen A: End-results after long-term unconsciousness due to head-injury. Psychiatr Neurol Neurochir 68:431–442, 1965

    • Search Google Scholar
    • Export Citation
  • 36.

    Langfitt TW: Measuring the outcome from head injuries. J Neurosurg 48:673678, 1978 Langfitt TW: Measuring the outcome from head injuries. J Neurosurg 48:673–678, 1978

    • Search Google Scholar
    • Export Citation
  • 37.

    Le Beau J, , Funck-Brentano JL, & Castaigne P: Le traitement des comas prolongés. Presse Med 66:829833, 1958 Le Beau J, Funck-Brentano JL, Castaigne P: Le traitement des comas prolongés. Presse Med 66:829–833, 1958

    • Search Google Scholar
    • Export Citation
  • 38.

    Lecuire J, , Dechaume JP, & Deruty DP: Long term prognosis of the prolonged and serious traumatic comas, in:Head Injuries. Edinburgh/London: Churchill Livingstone, 1971, pp 141144 Lecuire J, Dechaume JP, Deruty DP: Long term prognosis of the prolonged and serious traumatic comas, in: Head Injuries. Edinburgh/London: Churchill Livingstone, 1971, pp 141–144

    • Search Google Scholar
    • Export Citation
  • 39.

    Miller JD: The search for optimal management of head injury. MCV Q 13(3):97106, 1977 Miller JD: The search for optimal management of head injury. MCV Q 13(3):97–106, 1977

    • Search Google Scholar
    • Export Citation
  • 40.

    Mollaret P, & Goulon M: Le coma dépassé. Memoire preliminaire. Rev Neurol 101:315, 1959 Mollaret P, Goulon M: Le coma dépassé. Memoire preliminaire. Rev Neurol 101:3–15, 1959

    • Search Google Scholar
    • Export Citation
  • 41.

    Oddy M, , Humphrey M, & Uttley D: Subjective impairment and social recovery after closed head injury. J Neurol Neurosurg Psychiatry 41:611616, 1978 Oddy M, Humphrey M, Uttley D: Subjective impairment and social recovery after closed head injury. J Neurol Neurosurg Psychiatry 41:611–616, 1978

    • Search Google Scholar
    • Export Citation
  • 42.

    Overgaard J: Reflections on prognostic determinants in acute head injury, in McLaurin R (ed): Head Injuries. New York/San Francisco/London: Grune and Stratton, 1975, pp 1121 Overgaard J: Reflections on prognostic determinants in acute head injury, in McLaurin R (ed): Head Injuries. New York/San Francisco/London: Grune and Stratton, 1975, pp 11–21

    • Search Google Scholar
    • Export Citation
  • 43.

    Plum F, & Caronna JJ: Can one predict outcome of medical coma? in: Outcome of Severe Damage to the Central Nervous System, Ciba Foundation Symposium, Vol 34. Amsterdam: Elsevier, 1975, pp 121139 Plum F, Caronna JJ: Can one predict outcome of medical coma? in: Outcome of Severe Damage to the Central Nervous System, Ciba Foundation Symposium, Vol 34. Amsterdam: Elsevier, 1975, pp 121–139

    • Search Google Scholar
    • Export Citation
  • 44.

    Plum F, & Posner JB: The Diagnosis of Stupor and Coma, ed 2. Philadelphia: FA Davis, 1972 Plum F, Posner JB: The Diagnosis of Stupor and Coma, ed 2. Philadelphia: FA Davis, 1972

    • Search Google Scholar
    • Export Citation
  • 45.

    Reymond J, & Fau R: Coma traumatique exceptionnellement prolongé. Trépanation ou troisième mois. Guérison avec un minimum de séquelles. Med Acad Chir 82:3942, 1956 Reymond J, Fau R: Coma traumatique exceptionnellement prolongé. Trépanation ou troisième mois. Guérison avec un minimum de séquelles. Med Acad Chir 82:39–42, 1956

    • Search Google Scholar
    • Export Citation
  • 46.

    Rosenberg GA, , Johnson SF, & Brenner RP: Recovery of cognition after prolonged vegetative state. Ann Neurol 2:167168, 1977 Rosenberg GA, Johnson SF, Brenner RP: Recovery of cognition after prolonged vegetative state. Ann Neurol 2:167–168, 1977

    • Search Google Scholar
    • Export Citation
  • 47.

    Rossi GF: An attempt at interpretation of the apallic syndrome on the basis of experimental findings, in Dalle Ore G, , Gerstenbrand F, & Lücking CH, et al (eds): The Apallic Syndrome. Berlin/Heidelberg/New York: Springer-Verlag, 1977, pp 116124 Rossi GF: An attempt at interpretation of the apallic syndrome on the basis of experimental findings, in Dalle Ore G, Gerstenbrand F, Lücking CH, et al (eds): The Apallic Syndrome. Berlin/Heidelberg/New York: Springer-Verlag, 1977, pp 116–124

    • Search Google Scholar
    • Export Citation
  • 48.

    Schürmann K: Some ideas of a neurosurgeon about the necessity of organising the rehabilitation work. Scand J Rehabil Med 4:143149, 1972 Schürmann K: Some ideas of a neurosurgeon about the necessity of organising the rehabilitation work. Scand J Rehabil Med 4:143–149, 1972

    • Search Google Scholar
    • Export Citation
  • 49.

    Skillman JJ: Ethical dilemmas in the care of the critically ill. Lancet 2:634637, 1974 Skillman JJ: Ethical dilemmas in the care of the critically ill. Lancet 2:634–637, 1974

    • Search Google Scholar
    • Export Citation
  • 50.

    Skultety FM: Clinical and experimental aspects of akinetic mutism. Report of a case. Arch Neurol 19:114, 1968 Skultety FM: Clinical and experimental aspects of akinetic mutism. Report of a case. Arch Neurol 19:1–14, 1968

    • Search Google Scholar
    • Export Citation
  • 51.

    Sutter JM, , Bardenat C, & Phéline C, et al: La catatonie post-traumatique. Ses rapports avec les “états de décérèbration” et les comas prolongéd. Rev Neurol 100:524535, 1959 Sutter JM, Bardenat C, Phéline C, et al: La catatonie post-traumatique. Ses rapports avec les “états de décérèbration” et les comas prolongéd. Rev Neurol 100:524–535, 1959

    • Search Google Scholar
    • Export Citation
  • 52.

    Teasdale G, & Jennett B: Assessment of coma and impaired consciousness. A practical scale. Lancet 2:8184, 1974 Teasdale G, Jennett B: Assessment of coma and impaired consciousness. A practical scale. Lancet 2:81–84, 1974

    • Search Google Scholar
    • Export Citation
  • 53.

    Turazzi S, , Feriotti GA, & Bricolo A: Head injury survivors who remain unconscious. Acta Neurochir 48: 129, 1979 (Abstract) Turazzi S, Feriotti GA, Bricolo A: Head injury survivors who remain unconscious. Acta Neurochir 48:129, 1979 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 54.

    Vapalahti M, & Troupp H: Prognosis for patients with severe brain injuries. Br Med J 3:404407, 1971 Vapalahti M, Troupp H: Prognosis for patients with severe brain injuries. Br Med J 3:404–407, 1971

    • Search Google Scholar
    • Export Citation
  • 55.

    Vigouroux R, , Naquet R, & Baurand C, et al: Évolution électro-radio-clinique de comas graves prolongés post-traumatiques. Rev Neurol 110:7281, 1964 Vigouroux R, Naquet R, Baurand C, et al: Évolution électro-radio-clinique de comas graves prolongés post-traumatiques. Rev Neurol 110:72–81, 1964

    • Search Google Scholar
    • Export Citation
  • 56.

    Walker AE: Summary for the international symposium on rehabilitation in head injury. Scand J Rehabil Med 4:154156, 1972 Walker AE: Summary for the international symposium on rehabilitation in head injury. Scand J Rehabil Med 4:154–156, 1972

    • Search Google Scholar
    • Export Citation

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