Spindle coma: observations and thoughts.
The occurrence of physiological patterns of NREM sleep ("spindle coma") is well known since the first major study of Chatrian et al who--like most of the authors of subsequent studies--placed particular emphasis on the etiological role of CNS trauma. Further work showed that nontraumatic causes may also result in spindle coma. This study is based upon 11 observations of spindle coma extracted from 861 patients with acute severe CNS conditions. The age of the patients ranged from 6 months to 46 years. Metabolic, infectious and hypoxic problems were the most common etiologies; there was no case of CNS trauma. It is assumed that spindle coma represents a combination (i.e. coexistence) of true sleep and coma, the latter accounting for the failure of arousal that is attributed to impairment of the activating ascending reticular formation (midbrain level). The presence of spindles (and also vertex waves and K complexes) indicates relative integrity of the cerebral hemispheres. Such a constellation is more likely to occur in CNS trauma but--as our nontraumatic patient population shows--may also materialize in other types of CNS pathology.
Nogueira de Melo
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Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, Sao Paulo, Brazil.
Krauss
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Niedermeyer
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D000328:Adult; D001921:Brain / Q000503:physiopathology*; D003128:Coma / Q000175:diagnosis / Q000503:physiopathology*; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008297:Male; D012890:Sleep / Q000502:physiology*