Structural Causes of Stupor and Coma

Jerome B. Posner, Clifford B. Saper, Nicholas D. Schiff and Fred Plum

in Plum and Posner's Diagnosis of Stupor and Coma

Fourth edition

Published on behalf of Oxford University Press

Published in print February 2008 | ISBN: 9780195321319
Published online April 2013 | e-ISBN: 9780199322954 | DOI:

Series: Contemporary Neurology Series

Structural Causes of Stupor and Coma

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Two major classes of structural brain injuries cause coma (Table 3–1): (1) Compressivelesions may impair consciousness either by directly compressing the ascending arousal system or by distorting brain tissue so that it moves out of position and secondarily compresses components of the ascending arousal system or its forebrain targets (see herniation syndromes, page 95). These processes include a wide range of space-occupying lesions such as tumor, hematoma, and abscess. (2) Destructive lesions cause coma by direct damage to the ascending arousal system or its forebrain targets. To cause coma, lesions of the diencephalon or brainstem must be bilateral, but can be quite focal if they damage the ascending activating system near the midline in the midbrain or caudal diencephalon; cortical or subcortical damage must be both bilateral and diffuse. Processes that may cause these changes include tumor, hemorrhage, infarct, trauma, or infection. Both destructive and compressive lesions may cause additional compression by producing brain edema.

Chapter.  14444 words.  Illustrated.

Subjects: Neurology

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