Altered states of consciousness; Brain injury; Coma; Coma Recovery Scale-Revised; Consciousness; Diagnosis; Electroencephalography; Locked-in syndrome; Magnetic resonance; Minimally conscious state; Neuroimaging; Positron emission tomography; Prognosis; Transcranial magnetic stimulation; Treatment; Unresponsive wakefulness syndrome; Vegetative state; conscience, lésion cérébrale, diagnostic, pronostic, traitement, états de conscience altérée, coma, état végétatif, éveil non répondant, état de conscience minimale, locked-in syndrome, neuro-imagerie, tomographie par émission de positons, Coma Recovery Scale-Revised, imagerie par résonance magnétique, électroencéphalographie, stimulation magnétique transcrânienne
Résumé :
[fr] Les progrès de la médecine et des soins intensifs ont conduit à une augmentation du nombre de patients survivant à une lésion cérébrale sévère. Bien que certains patients récupèrent rapidement, d’autres demeurent dans un état de conscience altérée (ECA). Ces derniers peuvent évoluer du coma vers un état végétatif/syndrome d'éveil non répondant (EV/ENR), puis vers un état de conscience minimale (ECM). Dans cette revue, nous proposons tout d’abord de décrire les différentes méthodes, comportementales et de neuro-imagerie, utilisées dans le diagnostic des patients en ECA. Nous décrirons ensuite les facteurs susceptibles d’influencer le pronostic et la récupération de ces patients, ainsi que les traitements et la prise en charge qui peuvent être proposés dans le but d’améliorer leur état de conscience. Enfin, nous clôturerons cette revue avec une réflexion sur les considérations éthiques et les questions de fin de vie. [en] Advances in medicine and intensive care have led to an increase in the number of patients surviving a severe brain injury. Although some patients recover quickly, others remain in a state of altered consciousness. These patients can progress from a coma to a vegetative state or unresponsive wakefulness syndrome (VS/UWS) and later to a minimally conscious state (MCS). In this review, we first describe the different behavioral and neuroimaging methods used in the diagnosis of patients in an altered state of consciousness. We then describe the factors that can influence the prognosis and recovery of these patients, as well as the treatment and therapeutic management that can be proposed in order to improve their state of consciousness. Finally, we conclude this review by highlighting ethical considerations and end-of-life issues.
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