title: Neuroanatomical predictors of awakening in acutely comatose patients.
abstract: OBJECTIVE
  Lateral brain displacement has been associated with loss of consciousness and poor outcome in a range of acute neurologic disorders. We studied the association between lateral brain displacement and awakening from acute coma.
  
  
  METHODS
  This prospective observational study included all new onset coma patients admitted to the Neurosciences Critical Care Unit (NCCU) over 12 consecutive months. Head computed tomography (CT) scans were analyzed independently at coma onset, after awakening, and at follow-up. Primary outcome measure was awakening, defined as the ability to follow commands before hospital discharge. Secondary outcome measures were discharge Glasgow Coma Scale (GCS), modified Rankin Scale, Glasgow Outcome Scale, and hospital and NCCU lengths of stay.
  
  
  RESULTS
  Of the 85 patients studied, the mean age was 58 ± 16 years, 51% were female, and 78% had cerebrovascular etiology of coma. Fifty-one percent of patients had midline shift on head CT at coma onset and 43 (51%) patients awakened. In a multivariate analysis, independent predictors of awakening were younger age (odds ratio [OR] = 1.039, 95% confidence interval [CI] = 1.002-1.079, p = 0.040), higher GCS score at coma onset (OR = 1.455, 95% CI = 1.157-1.831, p = 0.001), nontraumatic coma etiology (OR = 4.464, 95% CI = 1.011-19.608, p = 0.048), lesser pineal shift on follow-up CT (OR = 1.316, 95% CI = 1.073-1.615, p = 0.009), and reduction or no increase in pineal shift on follow-up CT (OR = 11.628, 95% CI = 2.207-62.500, p = 0.004).
  
  
  CONCLUSIONS
  Reversal and/or limitation of lateral brain displacement are associated with acute awakening in comatose patients. These findings suggest objective parameters to guide prognosis and treatment in patients with acute onset of coma.
authors: Neurosciences Critical Care Division, Departments of Neurology, Neurosurgery, and Anesthesiology-Critical Care Medicine.
authors: Robert G
authors: RG
authors: Kowalski
authors: Manuel M
authors: MM
authors: Buitrago
authors: Josh
authors: J
authors: Duckworth
authors: Zachary D
authors: ZD
authors: Chonka
authors: H Adrian
authors: HA
authors: Puttgen
authors: Robert D
authors: RD
authors: Stevens
authors: Romergryko G
authors: RG
authors: Geocadin
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015331:Cohort Studies; D003128:Coma / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale / Q000639:trends*; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging / Q000639:trends; D011237:Predictive Value of Tests; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000639:trends; D014851:Wakefulness
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