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skywizard
19th February 2015, 15:39
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Although researchers have made remarkable advances in studying comas and other disorders
of consciousness, doctors say a great deal remains unknown. When a doctor walks into an
exam room, for example, the tools available for determining the prognosis of a patient in a
coma are limited -- and far from an exact science.

Now, researchers think they've found a measurement that will help doctors assess whether a patient will emerge from a coma.

“Coma is one of the most dreaded conditions,” Dr. Romer Geocadin, professor of neurology at The Johns Hopkins University School of Medicine and senior author of the new study, told Discovery News. “When patients are non-responsive from a traumatic brain injury or a stroke or tumor, for decades there’s been no real reliable marker of which patients will wake up.”

In fact, there are more reliable markers of which patients will do poorly, the researchers said.

“It’s been a one-way street,” Geocadin said.

That gave the researchers an idea: Using one of the most well-known tests for poor outcomes, they decided to test the reverse. In 1986, Dr. Allan Ropper discovered that a shift of the brain from its usual midline position is associated with loss of consciousness and poor outcome. Geocadin and lead author Robert Kowalski, a principal investigator at Craig Hospital in Englewood, Colorado, which specializes in spinal cord injury and traumatic brain injury, decided to measure whether patients whose brains shifted back toward midline had a better prognosis.

“No one had really looked at the converse; that's what we did,” Kowalski told Discovery News.

Bryan Young, professor emeritus in the neurology department at Western University in Ontario, Canada, who was not involved in the research, called the idea to follow up on Ropper's work "simple but brilliant."

Using a year’s worth of data from new coma patients at the Neurosciences Critical Care Unit at The Johns Hopkins Hospital, the researchers not only discovered a strong association between deviation from normal brain symmetry and emerging from coma, but they were also able to pinpoint a measurement (6 millimeters) at which the association seemed to indicate improved outcome.

“The message is to (consider more than) one factor in trying to give a prognosis to a patient's family and approach to therapy,” Kowalski said. “When a patient comes in who is comatose, (clinicians can consider this and other factors in determining) what are the chances they will wake up and what should we do therapeutically?” Kowalski said.



Source: http://news.discovery.com/human/health/simple-test-may-predict-if-a-coma-patient-will-wake-150218.htm



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