Cardiac Arrest, Coma, and Cerebral Death

  • Larry E. DavisEmail author
  • Sarah Pirio Richardson


The chapter begins with a discussion of common major clinical features and mechanisms of damage produced by hypoxia and ischemia. Consciousness has three attributes: arousal, wakefulness, and awareness of self and environment. Arousal is the ability to awaken from sleep and wakefulness and awareness are states of alertness. Pathologic states of consciousness include confusion (lack of clarity and coherence with speech at a slower speed than usual), delirium (confusion with agitation, restlessness, and fragmented slurred speech), obtundation (abnormal alertness associated with slow reaction times), stupor or semicoma (unconsciousness requiring constant strong verbal or physical stimuli to remain aroused), and coma (inability to arouse from any stimuli to produce appropriate responses). Etiologies causing coma are divided into 3 categories: supratentorial mass lesions, infratentorial destructive lesions, and metabolic causes.

Cerebral death involves the permanent loss of the capacity for consciousness, combined with the irreversible loss of the capacity to breathe. The U.S. Presidential Commission criteria for brain death heavily emphasize irreversible loss of brainstem functions. Anoxic death of neurons occurs by several factors that cascade once initiated. This chapter discusses the normal and abnormal states of consciousness, how anoxia and ischemia cause neuronal death, and the criteria to diagnose cerebral death. Attention is given to their pathophysiology, major clinical features, major laboratory findings, and principles of management and prognosis.


Confusion Delirium Obtundation Cerebral death Coma 

Recommended Reading

  1. Posner JB, Saper CB, Schiff ND, Plum F. The diagnosis of stupor and coma, 4rd ed. Oxford, Oxford University Press; 2007. (Comprehensive review of coma and its causes)Google Scholar
  2. Wijdicks EFM, Varelas PN, Gronseth GS, Greer DM. Evidence-based guideline update: determining brain death in adults. Neurology 2010;74:1911–8. (Reviews conditions necessary to fulfill criteria for brain death)PubMedCrossRefGoogle Scholar
  3. Monti MM, Laureys S, Owen AM. The vegetative state. Br Med J 2010;341:292–6. (Good review of what is and what is not a persistent vegetative state)CrossRefGoogle Scholar
  4. Young GB. Neurologic prognosis after cardiac arrest. N Engl J Med 2009;361:605–11. (Nice review of current status of cardiac arrest outcomes)PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2015

Authors and Affiliations

  1. 1.Chief Neurology ServiceDistinguished Professor of Neurology New Mexico VA Health Care SystemAlbuquerqueUSA
  2. 2.Department of Neurology Health Sciences CenterUniversity of New MexicoAlbuquerqueUSA

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