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For further information, see CMDT Part 24-17: Stupor & Coma

Key Features

  • A disorder of severely altered consciousness in which minimal but definite behavioral evidence of self- or environmental awareness is demonstrated

  • Distinct from locked-in syndrome and persistent vegetative state

  • Often follows major head trauma

  • May be temporary or permanent

  • Little information is available about its natural history or long-term outlook, which reflect the underlying cause

  • The likelihood of functional recovery diminishes with time; after 12 months, patients are likely to remain severely disabled and without a reliable means of communication

Clinical Findings

  • Inconsistent evidence of consciousness

  • There may occur some degree of functional recovery of behaviors suggesting self- or environmental awareness, such as

    • Basic verbalization or context-appropriate gestures

    • Emotional responses (eg, smiling) to emotional but not neutral stimuli

    • Purposive responses to environmental stimuli (eg, a finger movement or eye blink apparently to command)


  • Diagnosis usually made on clinical grounds

    • Functional imaging studies show that overall cerebral metabolism is less than in individuals with conscious awareness (20–40% of normal) but slightly higher, though comparable to, those in a persistent vegetative state

    • Functional MRI studies show some auditory network cortical activation in response to familiar voices


  • Amantadine (100–200 mg orally daily) may hasten recovery when given to patients in a minimally conscious or vegetative state 4–16 weeks after a traumatic brain injury

  • Otherwise, there is no evidence for any other measures that can alter the course of the recovery

  • Supportive care initially, which may include temporary endotracheal intubation and mechanical ventilation for airway protection, as well as liquid artificial nutrition by nasogastric or percutaneous gastrostomy tube

  • Palliative care and/or ethics committee consultation to assist families and clinicians in medical decision-making

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