Consciousness: its neurobiology and the major classes of impairment.

Consciousness: its neurobiology and the major classes of impairment.
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DOI:
10.1016/j.ncl.2011.08.001
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发表时间:
2011-11
期刊:
影响因子:
2.4
通讯作者:
Schiff, Nicholas D.
Schiff, Nicholas D.
中科院分区:
医学4区
文献类型:
--
作者:
Goldfine, Andrew M.;Schiff, Nicholas D.

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正常的人类意识需要脑干、基底前脑和间脑区域来支持一般性唤醒,以及功能性丘脑皮质网络来意识到并响应环境和内部刺激。这些互连系统的损伤或断开,通常来自心脏骤停和创伤性脑损伤,可导致意识障碍,包括昏迷、植物人状态、最低意识状态和运动不能性缄默症。类似的脑损伤也可能导致运动输出与意识不成比例的损失,从而导致意识障碍的误诊。我们回顾了病理学和影像学研究,并推导出这些条件的机制模型,以帮助个别患者的评估和预后。我们进一步建议,这些模型可以如何指导基于目标的治疗算法的发展,以提高这些患者的意识恢复。
Normal human consciousness requires brainstem, basal forebrain, and diencephalic areas to support generalized arousal, as well as functioning thalamocortical networks to become aware of, and respond to environmental and internal stimuli. Injury to or disconnection of these interconnected systems, typically from cardiac arrest and traumatic brain injury, can result in disorders of consciousness, including coma, vegetative state, minimally conscious state, and akinetic mutism. Similar brain injuries can also result in loss of motor output out of proportion to consciousness, resulting in misdiagnoses of disorders of consciousness. We review pathology and imaging studies and derive mechanistic models for each of these conditions, to aid in the assessment and prognosis of individual patients. We further suggest how such models may guide the development of target-based treatment algorithms to enhance recovery of consciousness in many of these patient.
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