Chapter

Prognosis in Coma and Related Disorders of Consciousness, Mechanisms Underlying Outcomes, and Ethical Considerations

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: http://dx.doi.org/10.1093/med/9780195321319.003.0672

Series: Contemporary Neurology Series

Prognosis in Coma and Related Disorders of Consciousness, Mechanisms Underlying Outcomes, and Ethical Considerations

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It is much more difficult to predict the outcome for patients with severe brain damage than to make the usually straightforward diagnosis of brain death. Brain death is a single biologic state with an unequivocal future, while severe brain injuries span a wide range of outcomes (Figure 9–1) depending on a number of variables that include not only the degree of neurologic injury, but also the presence and severity of medical complications. Scientific, philosophic, and emotional uncertainties that attend predictions of outcome from brain damage can intimidate even the most experienced physicians. Nevertheless, the problem must be faced; physicians are frequently called upon to treat patients with severe degrees of neurologic dysfunction. To do the job responsibly, the physician must organize available information to anticipate as accurately as possible the likelihood that the patient will either recover or remain permanently disabled. The physician’s role as a translator of medical knowledge is essential in counseling families who must make the ultimate decisions concerning the care of an unconscious patient. The financial and emotional costs of caring for those left hopelessly damaged can exhaust both family and medical staff. Physicians must attempt to reduce those burdens, while at the same time retaining an unwavering commitment to do everything possible to treat those who can benefit.

Chapter.  26292 words.  Illustrated.

Subjects: Neurology

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