andrew baker · andrew baker. coma: disorder of consciousness •critical and ultimate component of...
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Coma
Andrew Baker
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Coma: disorder of consciousness
• Critical and ultimate component of health
• Components include:• Alertness
• Attention
• Awareness
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1946
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1968
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1971
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2002
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Coma: disorder of consciousness
• Alertness (arousal)• Network of neurons: Ascending Reticular Activating
System
• Midbrain and rostral pontine tegmentum projecting to the diencephalon hypothalamus and midline and intralaminar nuclei of the thalamus – and on to projections to bilateral cortex.
• Awareness and Attention• Content of consciousness
• Sum of functions by cerebral cortical neurons and projections to and from subcortical structures
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Coma: disorder of consciousness
• Upper brainstem reticular formation and related structures
• Bilateral regions of the cerebral cortex
• Bilateral lesions of the thalamus
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• Vegetative State
– Wakefulness without awareness
• Sleep wake cycles; eye-open periods; lake of awareness of self or environment
• Minimally conscious state
– Severely impaired consciousness with minimal but definite behavioral evidence of self or environmental awareness
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Plum and Posner
The diagnosis of stupor and coma
1966
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Steven D. Colquhoun, Caroline A. Connelly
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Tate, 2012
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Take Home Messages
• Coma is a disorder of consciousness:
– Alertness, Attention, Awareness
• Anatomic Correlates vs. metabolic/structural
• Locked-in is not a coma-state
• SAE involves several parallel mechanisms
• Anatomy – Tracts -- BOLD -- DTI/Neuronal Pathways -- concept of the connectome