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Disorders of Consciousness: Common Findings in Brain Injury 

Disorders of Consciousness: Common Findings in Brain Injury
Chapter:
Disorders of Consciousness: Common Findings in Brain Injury
Author(s):

Calixto Machado

, Mario Estévez

, Rafael Rodríguez

, Mauricio Chinchilla

, and Jesús Pérez-Nellar

DOI:
10.1093/med/9780190279431.003.0007
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date: 22 February 2020

The disorders of consciousness (DOC) discussions are actual and permanent subjects for debate in the media and scientific discussion in any forum. Controversies exist in the use of present-day clinical terminology, including terms that may be pejorative in describing patients. Thw European Task Force on Disorders of Consciousness has proposed a new term, unresponsive wakefulness syndrome (UWS), to assist society in avoiding the depreciatory term “vegetative state” (VS). The author has submitted a response to the paper by Giacino et al., proposing the use of the term minimally aware state instead of minimally conscious state (MCS). The main finding in VS-UWS is the preservation of wakefulness with apparent loss of awareness. The diagnosis of VS-UWS has been made more difficult by recognition of the MCS as a transitional phase in the partial recovery of self-awareness or environmental awareness while emerging from the PVS-UWS, leading to a relative high proportion of errors. Neuroimaging techniques have expansively contributed to the study of DOC. In this area, the assessment of brain connectivity is essential to explain the pathophysiology of DOC. Magnetic resonance imaging (MRI) DW-MRT techniques have being widely used to estimate the nervous fiber pathways connecting brain regions of We propose to use graph theoretical approaches to differentiate the topological organization of white matter network in DOC. An accurate and reliable assessment of consciousness pathophysiology in DOC is critical for the subsequent management and rehabilitation, as well as medical, legal, and ethical decision-making.

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