自发性脑内出血患者意识水平与早期血肿扩大相关性的探讨

目的探讨大脑半球自发性脑内出血(ICH)患者意识水平与早期血肿扩大及血肿量的相关性,为血肿扩大的预测提供新指标.方法对87例发病后4h内CT诊断为大脑半球ICH患者,24h后复查CT,了解血肿扩大的发生情况,将结果与首诊时格拉斯哥昏迷评分(GCS)和脑实质内血肿量之间的关系进行分析.结果早期血肿扩大发生率为27.6%.经统计分析,在轻、中度意识障碍组(GCS 9～15分)GCS评分与血肿量呈正相关(P=0.011),在重度意识障碍组(GCS 3～8分)GCS评分仅与血肿扩大相关(P=0.026).结论患者就诊时GCS评分是大脑半球ICH早期血肿扩大的重要预测指标,血肿量不大而意识障碍严重高度提示血肿进行性生长.     

对护士实施格拉斯哥昏迷评分的评价

目的 为了解护士对意识障碍病人格拉斯哥昏迷评分(Glasgow Coma Scale，GCS)掌握的情况。方法 护士在神经外科ICU对意识障碍病人进行200次Clasgow昏迷评分，并对结果进行分析，组织护士学习前后的评分结果进行对比。结果 组织护士学习前GCS评分的正确率为62％，学习后的正确率为96％。结论 通过不断地学习和实践，对护士评分的正确性有很大帮助。建议ICU护士应不断加强学习，以期得出正确的结论，为病人的护理提供准确的依据。     

Libre de faire le mal ?

In the Eighties, Benjamin Libet demonstrated that we become aware of an action that happens several hundred milliseconds after the onset of the brain activity, suggesting that our voluntary decisions escape to our consciousness. This original experimental study has been replicated several times with the same results-even if their interpretations differ, which challenges scientifically the issue of free will. Thus, criminal Intentionality of psychopathic individuals could be re-examined. Using Edelman‘s Neural Darwinism, we developed the hypothesis that free will materializes in neural networks and we illustrate this by clinical case analysis. These have developed and perpetuated during the child development via their sensory experiences indexed with emotional values. These networks are stored in memory, and constitute a collection of our own individual habits which serve as a model for all our future decisions. General human and particularly psychopathic criminals would have even less latitude to act freely since their complexes have developed uniformly and rigidly during their childhood.     

Disorders of Consciousness: Outcomes,Comorbidities, and Care Needs

Over the last decade, research on patients with disorders of consciousness (DOC) has suggested that their prognosis for functional recovery early after injury is surprisingly positive, particularly for those with traumatic etiologies; that meaningful recovery proceeds for longer intervals than previously appreciated; and that such individuals are often medically complex and challenging to manage. However, access to intensive specialty rehabilitation is limited for most individuals with DOC in the United States. The evolving understanding of DOC calls for a reconsideration of appropriate models of care. This collection of articles provides insight into the functional recovery of individuals with DOC, new tools for assessing prognosis, and the patterns of comorbidity that complicate the recovery process. In addition, models of care from the United States and Europe that attempt to address the needs of patients as well as their caregivers are presented.     

Neuronal activity organization features in human consciousness: summary of introductory remarks in a dialogue with neurological surgery residents

Agreeing with Damasio’s statement defining the “process” of consciousness, we propose the self as created by mind-based knowledge and a combination of images of an organism’s intentional motor responses interacting with its environment. The lemniscal system, with plastic capabilities, manages gravity in voluntary movement. The spinal segment motor reflex represents the schema of gravity-managing neuronal activity, and it can become “nested” in cortical areas participating in consciousness-building, allowing consideration of the brain as a hyper-evolved nervous system segment harboring atavic spinal organization. Consciousness’ capability to change itself makes humans co-participants in their own mental and consciousness evolution.     

The Myth of Color Sensations,or How Not to See a Yellow Banana

I argue against a class of philosophical views of color perception, especially insofar as such views posit the existence of color sensations. I argue against the need to posit such nonconceptual mental intermediaries between the stimulus and the eventual conceptualized perceptual judgment. Central to my arguments are considerations of certain color illusions. Such illusions are best explained by reference to high-level, conceptualized knowledge concerning, for example, object identity, likely lighting conditions, and material composition of the distal stimulus. Such explanations obviate the need to appeal to nonconceputal mental links in the causal chains eventuating in conceptualized color discriminations.     

Detecting early recovery of consciousness: a comparison of methods

ABSTRACT

Early detection of the return of consciousness has important implications for prognosis and rehabilitation access. The aim of this study was to compare the Coma Recovery Scale–Revised (CRS-R) with individualised quantitative behavioural assessments (IQBA) to determine which method is capable of detecting command-following earlier and more consistently in persons with disorders of consciousness (DoC). Data from 27 patients with DoC, who underwent both assessments concurrently during inpatient rehabilitation, were retrospectively analysed. For each person, performance trajectories on the CRS-R auditory subscale item and IQBA dual command protocols were graphed together to identify earlier and more consistent evidence of consciousness; grouped data were analysed statistically. For 22 patients, IQBA more consistently documented consciousness than the CRS-R, whereas no patients showed the reverse pattern. For 14 of 20 analysable patients, IQBA provided earlier evidence of consciousness, for two patients CRS-R provided earlier evidence, and for four patients both methods provided initial evidence on the same day. These findings suggest that IQBA approaches can provide more consistent and earlier evidence of command-following than the comparable item on the CRS-R. Whether this advantage is due to the individualisation of IQBA or the greater volume of data gathered requires further research.     

There are things that we know that we know,and there are things that we do not know we do not know: Confidence in decision-making

Metacognition, the ability to think about our own thoughts, is a fundamental component of our mental life and is involved in memory, learning, planning and decision-making. Here we focus on one aspect of metacognition, namely confidence in perceptual decisions. We review the literature in psychophysics, neuropsychology and neuroscience. Although still a very new field, several recent studies suggest there are specific brain circuits devoted to monitoring and reporting confidence, whereas others suggest that confidence information is encoded within decision-making circuits. We provide suggestions, based on interdisciplinary research, to disentangle these disparate results.