This week’s Green Journal has an interesting fMRI study in which the authors identify specific lesional areas in the pontine tegmentum that are associated with coma. The study raises the possibility that such imaging could be useful in the diagnosis and prognosis of disorders of consciousness. This is important because, as the accompanying editorial points out, the risk of misdiagnosis is quite high in such disorders.
The assessment of consciousness offers yet another example of where adherence to protocols can improve clinical performance. There’s a tool called the Coma Recovery Scale – Revised that has been shown to be superior to clinical consensus in differentiating the vegetative state from the minimally conscious state. I added a “Rehab” entry to the clinical neurology resources in the menu above, with a link to this scale. It appears to be somewhat cumbersome, but worthwhile. After all, the stakes can be high in such cases, as decisions about the intensity of care may hinge on the neurologist’s assessment. Moreover, to the extent that such cases sometimes engender disputes among family members and between families and the clinical teams, employing a validated tool could be helpful in achieving consensus.