A Comatose State in Search of a Name: A History of Its Terminology and Semiology

Excerpt

Notwithstanding the pertinent legal and societal implications of applying neuroimaging and new research to “responsiveness” in prolonged coma [1, 2], neurologists and neurosurgeons for decades have recognized states from which no one (or almost no one) substantially recovered or even awakened. Clearly, a large number of the patients who did recover were initially misdiagnosed and received an unduly bleak prognosis. However, rehabilitation physicians in particular [3] recognized that referred patients who had been “unresponsive” became more awake, albeit minimally so. The history of the semiology of prolonged unconsciousness can be best summarized as initial multiple attempts to describe the indescribable and indefinable, a presumed resolution after Jennet and Plum’s article in 1972 [3], and a Multi-Society Task Force recommendation in 1994 [4, 5]. Why was it so difficult to reach the skills to make this diagnosis and where did we fall short? A survey of the past may provide insights. …