Coma and Brain Death

Alejandro A. Rabinstein, MD, FAAN p. 1708-1731 December 2018, Vol.24, No.6 doi: 10.1212/CON.0000000000000666
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PURPOSE OF REVIEW: This article discusses the diagnostic and therapeutic approach to patients who are comatose and reviews the current knowledge on prognosis from various causes of coma. This article also provides an overview of the principles for determination of brain death as well as advice on how to avoid common pitfalls.

RECENT FINDINGS: Technologic advances have refined our understanding of the physiology of consciousness and the spectrum of disorders of consciousness; they also promise to improve our prognostic accuracy. Yet the clinical principles for the evaluation and treatment of coma remain unaltered. The clinical standards for determination of death by neurologic criteria (ie, brain death) are also well established, although variabilities in local protocols and legal requirements remain a problem to be resolved.

SUMMARY: Effective evaluation of coma demands a systematic approach relying on clinical information to ensure rational use of laboratory and imaging tests. When the cause of coma is deemed irreversible in the setting of a catastrophic brain injury and no clinical evidence exists for brain and brainstem function, patients should be evaluated for the possibility of brain death by following the clinical criteria specified in the American Academy of Neurology guidelines.

Address correspondence to Dr Alejandro A. Rabinstein, 200 1st St SW, Rochester, MN 55905, rabinstein.alejandro@mayo.edu.

RELATIONSHIP DISCLOSURE: Dr Rabinstein receives royalties from Elsevier and Oxford University Press and has received research support from DJO Global, Inc.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Rabinstein reports no disclosure.

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© 2018 American Academy of Neurology