The first Report on Progress this year comes from Thomas I. Cochrane, M.D., MBA Neurology, Brigham & Women’s Hospital, and Michael A. Williams, M.D., FAAN, The Sandra and Malcolm Berman Brain and Spine Institute LifeBridge Health. The doctors take the readers through two possible stages of consciousness after injury, using a case study approach.
“Approximately five minutes after a terrible car accident that ejected Matt Trenton from his car, first responders found him face down and not breathing. They placed an endotracheal (breathing) tube in his trachea (windpipe) and transported him to the hospital, where he was admitted to the ICU. He received treatments, such as medications to elevate blood pressure, ventilator support of breathing, and IV fluids for hydration, all of which are necessary to support the brain and the body so that the brain can recover from injury.
Although Matt’s vital organs were not seriously injured, a CT scan showed widespread swelling of the brain. Dr. Roberts, a neurologist, evaluated him. Matt was still in the bed and didn’t move spontaneously. When blood was drawn from his arm, he did not move it or even wince. When Dr. Roberts shouted Matt’s name and applied painful stimuli to assess his level of consciousness, his eyes did not open. When she held his eyes open, no spontaneous eye movements were evident, nor did he look at her face. A review of Matt’s medications and the lab and toxicology tests showed the presence of no substances that might worsen Matt’s neurologic exam. Therefore, it was clear that Matt had sustained severe brain damage that was causing severely impaired consciousness—i.e., coma. Matt’s parents asked Dr. Roberts if Matt was conscious or unconscious and whether he was likely to recover.”
The article goes on to discuss consciousness, awareness, coma, vegetative and minimally conscious states and brain death.
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