Disorders of consciousness (DOC) represent one of the most complex
and crucial challenges for neuroscientists. A precise and reliable
assessment of the arousal and awareness of consciousness in
patients with severe brain damage would allow for a comprehensible
classification of DOC. Intensive care has led to an increase in the
number of patients who survive after severe acute brain damage.
Most comatose patients who survive begin to awaken and recover
gradually within 24 weeks. Although some of these individuals
gradually experience complete brain function loss which leads to
brain death (BD), oftentimes this state is treated as synonymous
with the death of the individual. Nonetheless, other individuals
progress to "wakeful unawareness", which is defined as a vegetative
state (VS). DOC terminology may be useful clinically, but does
little to explain the nature of consciousness. While it is not
known which portions of the brain are responsible for cognition and
consciousness, what little is known points to substantial
interconnections among the brainstem, subcortical structures and
the neocortex. Thus, the "higher brain" may well exist only as a
metaphorical concept and not in reality.
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