DIAGNOSTIC AND PRONOSTIC VALUES OF BRAIN STERN REFLEXES IN SEVERE TRAUMATIC COMAS

  • 1 January 1977
    • journal article
    • research article
    • Vol. 23  (3) , 227-238
Abstract
The neurological evolution of 50 cases of traumatic coma were studied, and 5 levels of dysfunction corresponding to 5 steps of rostrocaudal deterioration were recognized. Level 1 (cortico-sub-cortical) was defined by the persistence of the mimic and flexion response to painful stimulation. Level 2 (diencephalic) was characterized by stereotypic responses to pain and lack of mimic response. At these 2 levels, the fronto-orbicular and vertical oculo-vestibular reflexes were persistent. These reflexes disappeared when level 3 (meso-diencephalic junction) was reached. The photomotor reflex disappeared at the level 4 (mesencephalic), while the motor response to pain may be very poor, or may be a bilateral extension. The horizontal oculo-vestibular reflex was always present, except for level 5, corresponding to a pontine lesion. The meso-diencephalic level 3 appeared to be a critical impairment point: as long as this level is not passed, half of the patients improved and only 10% died. More than 75% of those who improved from this level had an excellent recovery. The rehabilitation probability was diminished by half when the level of mesencephalic dysfunction was reached.

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