title: Coma and cerebral imaging.
abstract: The clinical sign of coma is a common feature in critical care medicine. However, little information has been put forth on the correlations between coma and cerebral imaging methods. The purpose of the article is to compile the available information derived from various imaging methods and placing it in a context of clinical knowledge of coma and related states. The definition of coma and the cerebral structures responsible for consciousness are described; the mechanisms of cerebral lesions leading to impaired consciousness and coma are explained. Cerebral imaging methods provide a large array of information on the structural changes of brain tissue in the various diseases leading to coma. Circumscript lesions produce space-occupying masses that displace the brain, ultimately leading to various types of herniation. Generalized disease of the brain usually leads to diffuse brain swelling which also can cause herniation. Epileptic states, however, rarely are detectable by imaging methods and mandate EEG examinations. Another important aspect of imaging in coma is the increasing use of functional imaging methods, which can detect the function of loss of function in various areas of the brain and render information on the extent and severity of brain damage as well as on the prognosis of disease. The MRI methods of (1)H-spectroscopy and diffusion tensor imaging may provide more functional information in the future.
authors.affiliation: Department of Neurology, University of Cologne, Kerpener St. 62, 50937 Cologne, Germany.
authors.forename: Walter F
authors.initials: WF
authors.lastname: Haupt
authors.affiliation: Department of Neurology and Psychiatry, Friedrich-Ebert Krankenhaus, Friesenstr. 11, 24534 Neumünster, Germany.
authors.forename: Hans Christian
authors.initials: HC
authors.lastname: Hansen
authors.affiliation: Landwehrweg 12c, 62350 Bad Homburg, Germany.
authors.forename: Rudolf W C
authors.initials: RW
authors.lastname: Janzen
authors.affiliation: Department of Neurosurgery, Otto-von-Guericke University Magdeburg, Leipzigerstr 44, 39120 Magdeburg, Germany.
authors.forename: Raimund
authors.initials: R
authors.lastname: Firsching
authors.affiliation: Department of Neurology, University of Cologne, Kerpener St. 62, 50937 Cologne, Germany ; Research Center Juelich, 52425 Juelich, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Galldiks
keywords: Brain death; Brain disease; Coma; Computed tomography (CT); Functional Magnetic Resonance Imaging (fMRI); Magnetic Resonance Imaging (MRI)