Resumen
El estado de coma es un síndrome caracterizado por inconsciencia resistente a estímulos externos. El coma puede ser de origen metabólico o estructural. Los objetivos primordiales de la valoración inicial del paciente en coma son: mantener la via aérea y la circulación; determinar la presencia de signos focales; empezar tratamiento empírico o actual de las entidades de base sospechadas. El examen neurológico debe comprender el nivel de consciencia, los pares craneanos, el patrón respiratorio, y la función motriz de las cuatro extremidades.
Citas
Plum F, Posner JB. The diagnosis of stupor and coma. 3rd Ed. Philadelphia: F.A. Davis 1982
Saper CB. Brain stem modulation of sensation, movement and consciousness. In: Kandel ER, Schwartz JH, Jessell TM. Principles of neural science. 4th Ed. New York: McGraw Hill 2000: 889-909
Jennett B, Plum F. Persistent vegetative state after brain damage: a syndrome in search of a name. Lancet 1972;1: 734-737
Levy DE, Bates D, Caronna JJ, et al. Prognosis in non- traumatic coma. Ann Intern Med 1981; 94: 293-301
The Multi-Society Task Force on PVS. Medical aspects of the persistent vegetative state- First of two parts. NEJM 1994; 330: 1499-1508
The Multi-Society Task Force on PVS. Medical aspects of the persistent vegetative state- Second of two parts. NEJM 1994; 330: 1572-1579.
Gennarelli TA, Thibault LE, Adams JH, Graham DI, Thompson CJ, Marcincin RP. Diffuse axonal injury and traumatic coma in the primate. Ann Neurol 1982; 12: 564-574.
Adams JH, Graham DI, Jennett B. The neuropathology of the vegetative state after an acute brain insult. Brain 2000; 123: 1327-1338.
Giacino GT, Ashwal S, Childs N, et al. The minimally conscious state. Definition and diagnostic criteria. Neurology 2002; 58: 349-353.
Shewmon DA. The minimally conscious state. Definition and diagnostic criteria. (letter) Neurology 2002; 58: 506.
Coleman D. The minimally conscious state. Definition and diagnostic criteria. (letter) Neurology 2002; 58: 506.
Cartlidge N. States related to or confused with coma.
J Neurol Neurosurg Psychiatry 2001; 71 (Suppl 1): i18-i19.
Patterson JR, Grabois M. Locked in syndrome: A review of 139 cases. Stroke 1986; 17: 758-764.
McCusker EA, Rudick RA, Honch GW, et al. Recovery from the locked in syndrome. Arch Neurol 1982; 39:
-147.
Fisher CM. Some neuro-ophthalmological observations. J Neurol Neurosurg Psychiatry 1967; 30: 383-392.
Bates D. The prognosis of medical coma. J Neurol Neurosurg Psychiatry 2001; 71 (Suppl 1): i20-i23.
Snyder . Neurologic prognosis after cardiopulmonary arrest: IV. Brainstem reflexes. Neurology 1981;31: 1092-1097.
Pazzaglia P, Frank G, Frank F, Gaist G. Clinical course and prognosis of acute post-traumatic coma. J Neurol Neurosurg Psychiatry 1975; 38: 149-154.
Andrews BT. Prognosis in severe head injury. In: Cooper PR, Golfinos JG, eds. Head injury. 4th Ed. New York: McGraw-Hill 2000: 555-563
Leigh, RJ, Zee DS. The Neurology of Eye Movements, 4th Ed (Text/CD). New York: Oxford University Press, 2006.
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.