Clinical Issues in the Management of Unconsciousness and Vegetative State Patients

  • Nariyuki Hayashi
  • Dalton W. Dietrich


Unconsciousness is diagnosed by the lack of response to verbal, painful and other external stimulation [7]. Lesions include brainstem reticular formations, whole brain mantle cortex, and interconnection brain between the cortices and reticular formation. However, after use of brain hypothermia treatment that includes treatment for stress-associated hypothalamus-pituitary-adrenal (HPA) axis neurohormonal dysfunction [4], many herniated patients, who would previously have been considered to have a low chances of survival using intracranial pressure (ICP)-oriented treatment, have survived [2,5]. In this group, we have observed many patients whose recoveries are difficult to explain and understand by the previous diagnostic method of the Glasgow Coma Scale (GCS) [7].


Glasgow Coma Scale Reticular Formation Brain Damage External Stimulation Severe Brain Injury 
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Copyright information

© Springer Japan 2004

Authors and Affiliations

  • Nariyuki Hayashi
    • 1
    • 2
  • Dalton W. Dietrich
    • 3
    • 4
  1. 1.Nihon University Emergency Medical CenterTokyoJapan
  2. 2.Department of Emergency and Critical Care MedicineNihon University School of MedicineTokyoJapan
  3. 3.Department of Neurological Surgery, Neurology and Cell Biology and AnatomyUniversity of Miami School of MedicineMiamiUSA
  4. 4.The Miami Project to Cure ParalysisMiamiUSA

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