Distinguishing disorders of consciousness and related conditions

Condition	Characteristic description	Arousal	Awareness	Homeostatic functions^*	Movement	Common location of brain injury
(Brain) death	Irreversible, permanent cessation of brain functions	(–)	(–)	Absent	Spinal reflexes only	Entire brainstem
Coma	Unarousable unawareness	(–)	(–)	Impaired	Reflex posturing with extremities Cranial nerve reflexes	Ascending reticular activating system in upper brainstem tegmentum or bilateral hemispheres
Vegetative state/ unresponsive wakefulness syndrome^¶	Wakefulness without awareness	(+)	(–)	Preserved	Spontaneous eye opening Reflex posturing with extremities Cranial nerve reflexes	Variable brainstem or bilateral hemispheres
Cognitive motor dissociation	Awake and aware, but unable to produce volitional movement or speech^Δ	(+)	(+)^Δ	Preserved	Reflex posturing with extremities Cranial nerve reflexes Eye opening/gaze tracking may be present	Bilateral thalamus, hemispheres
Locked-in syndrome	Awake and aware, responds only by eye movement	(+)	(+)	Preserved	Spontaneous eye movements, blinking	Pontine base +/– tegmentum
Minimally conscious state	Wakefulness with partial awareness	(+)	(+)	Preserved	Variable spontaneous or responsive motor activity^◊	Variable brainstem or bilateral hemispheres
Akinetic mutism	Absent/minimal volitional movement	(+)	(+)	Preserved	Spontaneous eye movements Postural tone/reflexes intact	Cingulate gyrus, bilateral hemispheres
Catatonia	Inability to move despite physical ability to do so	(+)	(+)	Preserved	Posturing, stereotypies Variable presence of agitation, echolalia, or behavioral mannerisms	None (functional alterations in cortico-basal pathways may be seen in some patients)

Disorders of consciousness include several conditions that represent a continuum of brain injury. They are characterized by specific neurologic deficits and preserved neurologic functions and may be associated with a variety of cerebral conditions.

EEG: electroencephalogram; fMRI: functional magnetic resonance imaging; MCS: minimally conscious state.

* Includes sleep-wake cycles, temperature and blood pressure regulation, digestion, growth.

¶ Formerly also called "apallic syndrome" or "coma vigil."

Δ Awareness with preserved cognitive function can be identified by diagnostic testing including task-based EEG or fMRI of the brain.

◊ MCS is a heterogenous condition as some patients with severe impairments only localize painful stimuli (MCS minus) while other may follow some commands and use some verbal communication (MCS plus).

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Distinguishing disorders of consciousness and related conditions