Neurocirurgical Assessment of Coma - Review

Solapas principales

Nunes N. 1, Nunes N. 2, Pereira C. 3, Moura C. 1, Alves G. 1, França F. 1, Alves G. 1, Rocha D. 4. Delourence G. 5, Araujo L. 2


          The metabolic coma is the most prevalent and the exogenous toxic represent 1-2% in emergencies are by patients with level of consciousness dismissed. Describe the anatomic and pathophysiology of comatose patient, make the clinical exam and propose a flowchart and table directing the different possible diagnoses, and its etiologic treatment.  A review of the data base LILACS, Medline and PubMed, with the keywords: Glasgow coma scale, coma post-head injury, coma and brain death. 39 reviews were selected, for this article, period of 1981-2017. Three basic structures are responsible for maintaining awake and consciousness: the ascending reticular activating system (ARAS), the cerebral hemisphere and the limbic system. In clinical exam it is important to evaluate: 1) The consciousness, that is the most elementary mental superior function, examining it by the level and content of consciousness. 2) The respiratory pattern that reflects indirectly on the neurologic damage. Two are important: Biot and Cheyne-Stokes. 3) Pupil exam by its form, size and reactivity. 4) The motor evaluation is not a good parameter to examine the level and content of consciousness. The importance of a well done physical exam and anamnesis, and the correct definition of the etiology of coma are the main concerns to the treatment and the potential reversible coma, on time, without leaving any neurologic damage.

Key Words:Disorder of consciousness, rehabilitation, coma, coma management, neurosurgery



  1. Medical Student - Faculdade Atenas de Medicina; Paracatu, Minas Gerais, Brazil
  2. Department of Neurosurgery - Hospital Santa Casa; Ribeirão Preto, São Paulo, Brazil
  3. Department of Neurosurgery of FBHC and Neurosurgery Service, Aracaju, Sergipe, Brazil
  4. Department of Cardiology and  Internal Medicine - Faculdade Atenas; Paracatu, Minas Gerias, Brazi
  5. Medical Student - FEMA - Fundação Educacional do Município de Assis; Assis, São Paulo