Post-traumatic apallic syndrome following head injury .1. Clinical characteristics

Author(s): Hagel, K.

Journal/Book: Disabil Rehabil. 1996; 18: 4 John St, London, England WC1N 2ET. Taylor & Francis Ltd London. 1-20.

Abstract: Epidemiological studies made within the western countries indicate an incidence of 200-300 traumatic head injuries per 100 000 residents each year. Severe head injuries account for 5-25% of all head injuries; 10-14% of all severe head-injured patients develop into a vegetative state, in which a sleep-wake rhythm is apparent, but however in which there is no evidence of awakeness or reactivity to the environment. The most commonly used labels, in the German and international literature, for these patients are 'vegetative state', 'apallic syndrome' and 'coma vigile'. This clinical characterization is not sufficient. It is necessary to employ additional criteria to distinguish subsets of vegetative patients e.g. computerized tomography, magnetic resonance imaging, single photon emission tomography, electroencephalography, brainstem reflexes, evoked potentials, assessment scales, age, premorbid brain disorders. Diagnostic and prognostic parameters must form the basis for various decisions relating to patients' care and intervention.

Note: Review K Hagel, Neurol Klin Elzach Schwarzwald, Postfach 1262, D-79213 Elzach, Germany

Keyword(s): head injury; coma; apallic syndrome; vegetative state; PERSISTENT VEGETATIVE STATE; DISABILITY RATING-SCALE; GLASGOW COMA SCALE; MULTIMODALITY EVOKED-POTENTIALS; BRAIN-STEM REFLEXES; PROLONGED POSTTRAUMATIC UNAWARENESS; EARLY OUTCOME PREDICTION; DIFFUSE AXONAL INJURY; CEREBRAL BLOOD-FLOW; PROGNOSTIC VALUE

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