Chapter 11: Predictors for Prognosis and Recovery from Unconsciousness Due to Brain Trauma

The main objective of this chapter is to facilitate the study of structural, hemodynamic and biochemical brain changes during consciousness recovery after severe traumatic brain injury using the results of clinical examinations and neuroimaging. The main descriptions of different unconsciousness variants and their anatomical, neurotransmitter and pathophysiologic bases are discussed. A novel magnetic resonance imaging classification of localization of the brainstem and hemispheric structural damage has been proposed. This classification significantly correlates with the Glasgow Coma Scale and Glasgow Outcome Scale, thus proving its prognostic value. New data on pathogenesis and dynamics of diffuse brain injury with quantitative and qualitative changes in the white matter fiber tracts have been obtained. It was demonstrated that diffuse axonal injury, being a trigger mechanism of fiber tract degeneration with their subsequent atrophy, may be regarded as a clinical model of the multidimensional “split brain”. Quantitative blood flow parameters in the brainstem using computed tomography perfusion have been studied in comatose patients with regard to the dynamics of the traumatic brain disease and its outcome. The comparison of clinical signs of trauma severity and outcome and qualitative and quantitative parameters of structural brain damage, cerebral blood flow and molecular biomarker changes helped to identify significant criteria for the consciousness recovery prognosis.