Research Reports - Clinical signs of recovery in patients with unresponsive wakefulness syndrome after traumatic brain injury

J Neurotrauma. 2016 May 31. [Epub ahead of print]

Bagnato S(1), Boccagni C(1), Sant'Angelo A(1), Fingelkurts AA(2), Fingelkurts
AA(2), Galardi G(1).

Although clinical examination is the gold standard for differential diagnosis
between unresponsive wakefulness syndrome (UWS) and minimally conscious state
(MCS), clinical signs denoting the first occurrence of conscious behavior in
patients with UWS have not been clarified. In this prospective single-center
cohort study, 31 consecutive patients with UWS after traumatic brain injury (TBI)
(17 patients) or non-TBI were assessed with the Coma Recovery Scale Revised
(CRS-R) at admission to a rehabilitation department and after 1, 2, 3, 6, and 12
months. Of the 21 patients who recovered consciousness during the study, 90.5%
recovered consciousness within the first 3 months. At the first diagnosis of
emergence from UWS, 52.4% of patients showed signs of awareness in only one CRS-R
subscale. In particular, 42.9% of patients showed conscious behaviors on the
visual CRS-R subscale (23.8% showed visual fixation and 19.1% showed visual
pursuit), and 9.5% showed conscious behaviors on the motor CRS-R subscale (half
showed localization to a noxious stimulus and half showed object manipulation).
Moreover, 23.8% of patients had conscious behaviors on two CRS subscales, always
involving the visual and motor CRS-R subscales. The remaining patients showed
conscious behaviors on more than two CRS-R subscales. In conclusion, visual
fixation and visual pursuit are the commonest early clinical signs denoting MCS.
When emerging from UWS, patients with TBI often showed more signs of
consciousness and had higher CRS-R scores than patients with non-TBI. 

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