Brain function in coma, vegetative state, and related disorders

Laureys, Owen, Schiff · The Lancet. Neurology · 2004 · neuroscience · 10.1016/s1474-4422(04)00852-x · record Laureys2004-brain-function-in-coma-vegetative-state-and
tag layer · index · concepts · authors · עברית
Where this record's text came from. faceted 2026-08 by reading the locally held text (pdftext); every evidence string verified as an exact substring of that text before merging. Claim relations is empty: the review cites all prior work by superscript numbers rather than by name, and the few named mentions (Jennett and Plum on the term 'vegetative', Plum and Posner on locked-in syndrome, the Aspen group on MCS criteria, the Multi-Society Task Force on PVS) are descriptions of where the clinical terminology came from, not statements positioning this paper's own claim against named prior work. Per the rule against inferring relations from bare citations, none were recorded. Claim type is 'mechanism' rather than 'critique' because the review's substantive content is the functional neuroanatomy of each state; the caution about neuroimaging not replacing clinical exam is a secondary conclusion. The source text is a preprint-style manuscript whose running title and word counts appear above the abstract. 2026-08-14 and 2026-08-15 schema-0.3 passes: every quote verified as an exact substring of the staged text and anchored at merge time; concept terms verified present; every edge endpoint an existing node. 2026-08-20, the project: THE STAGED TEXT IS THE ACCEPTED MANUSCRIPT, NOT THE PUBLISHED VERSION, and it carries a different title - "Brain function in brain death, coma, vegetative state, minimally conscious state and locked-in syndrome" against the record's published "Brain function in coma, vegetative state, and related disorders". The published title shortens the manuscript's list to 'related disorders', which is why the record's title occurs ZERO times in its own body and why a title-containment test flags this record. It is NOT the wrong paper: same three authors in the same order (Laureys, Owen, Schiff), same year, same content (brain death, coma, VS, MCS, locked-in, PET/fMRI/MEG, ethics), author-manuscript formatting with postal addresses and fax numbers, 115 references stopping in 2003, and NO self-citation to the Lancet Neurology 2004 version - which a later or different paper by these authors would carry. Every quote remains an exact substring of this text; what differs is which VERSION of the paper the corpus holds.
This record’s own method is review, and the tags below follow from that. A review’s findings, quantities and statistics are things stated IN this paper, and some of them report results obtained elsewhere. No tag on this page names a different author. Measured across every review in this corpus, 81% of a review’s tags carry no citation at all — most of them are the review speaking. The corpus does not adjudicate the rest: read an unmarked tag as a claim this paper makes, not necessarily one it made first.
How to read this page. The article itself is not reproduced here — this paper is not cleared for redistribution, so what follows is the tag layer alone. The evidence sentences are withheld with the article. The table at the foot lists every tag the record carries; each row names the facet it belongs to, and the whose words column says whether the tag records the paper's own wording or the tagger's sentence about the paper. Every tag links to each other paper in the corpus carrying it. The machine-readable edition of the same thing is the TEI file beside this one, where the tags live in standOff, and the article is at its publisher via the link below. When we have changed our mind. Some entries in the table begin with a word in capitals and the reason for it. EVIDENCE CORRECTED — the finding still stands, but we had quoted the wrong sentence from the paper, and the quotation has been replaced with the right one. RETRACTED — the entry itself was wrong; it stays on the page, marked, with the reason, rather than being deleted. WITHDRAWN AND REPLACED — the entry was wrong, and a corrected version of it appears in the entries below. Each mark carries its own reason, in brackets, because the reasons differ from one entry to the next. An entry we have WITHDRAWN is removed from this page and kept in the record, with its reason. A line reading Audit and a date is a later re-reading of the entry against its whole sentence: DOUBTFUL means it was kept, and the reason says what is loose about it. Quotation marks inside the tagger's sentence. Where a tag is the tagger's own sentence, a phrase in quotation marks inside it is borrowed from the paper — the tagger's wording around it is not. The paper's own sentence is the evidence quote for that row; on this page it is withheld with the article, and the article is at its publisher. Nothing inside quotation marks anywhere on this page is ours: if it is quoted, it is the paper's. Whose words a concept carries. A concept entry records a term the paper itself uses, so the term, the sense given for it, and its evidence are the paper's own words, quoted where the paper fixes them. This is the opposite of a sense entry in the tag table, which is the tagger's sentence about how the paper uses a term. Where a concept entry could not be grounded in the paper's words, the entry says so on its own row.
Other fields define these differently the same word, defined another way in another discipline
consciousness 10 fields

Tags on this paper

Every tag the record carries, each linking to every other paper in the corpus that carries it. A tag appears here whether or not its words occur in the article — the spans below are only the ones a sentence in this paper licenses. Of the 3 concept tags on this paper, all 3 are grounded in a quoted sentence.
brain death minimally conscious state consciousness progressive Wallerian and transsynaptic neuronal degeneration drives the further fall of brain metabolism as a vegetative state becomes permanent sparing of brainstem structures (pedunculopontine reticular formation, hypothalamus, basal forebrain) preserves arousal and autonomic function while the cortex is impaired, producing wakeful unawareness functional disconnection of primary sensory cortex from multimodal and limbic areas stops residual cortical processing from reaching the integrative stage held to be necessary for awareness coma persistent vegetative state locked-in syndrome hollow skull phenomenon review

Legend

relation to other workclaim_relationshow this paper stands to another: agrees, contradicts, extends, qualifies
claim typeclaim_typethe shape of the claim: existence, mechanism, method, critique, prediction, null
conceptconceptsan idea the paper works with, quoted where the paper uses it
content tagcontent_tagsa finding, definition, quantity, statistic or variable named in the paper
controlcontrolsan experiment run to eliminate a rival explanation
limitationlimitationswhat the paper says its evidence cannot support
mechanismmechanismshow the reported effect is said to come about
methodmethodhow the paper produced its evidence
phenomenonphenomenonthe effect or regularity under study
sensesensesa distinct use of a term, quoted where the paper fixes it

The paper

The full text is not reproduced here. This article is not cleared for redistribution, so the page carries the tag layer only. Its evidence sentences are withheld; the grounding status remains with each tag, and the article itself is at https://doi.org/10.1016/s1474-4422(04)00852-x. The reading view exists for the papers whose licence permits it.

Every tag on this page

claim_relations 2 · claim_type 1 · concepts 3 · content_tags 19 · controls 1 · limitations 7 · mechanisms 3 · method 1 · phenomenon 1 · senses 4

This record holds no relations between concepts. A layer is empty when the tagger recorded nothing in it — which is not the same as the paper having nothing to record.

facettagfieldconf.whose words
claim_typemechanism
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
claim_typethe paper's words
phenomenondisorders of consciousness after severe brain damage
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phenomenonthe paper's words
methodreview
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also in: review
methodthe paper's words
mechanismsmechanisms
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
mechanisms[0]the tagger's words
mechanismsmechanisms
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
mechanisms[1]the tagger's words
mechanismsmechanisms
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
mechanisms[2]the tagger's words
limitationsThe imaging methods reviewed are hard to apply and interpret in this patient population.
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
what this limits: this patient population specifically: USE OF THESE TECHNIQUES IN SEVERELY BRAIN-DAMAGED PERSONS IS METHODOLOGICALLY COMPLEX AND REQUIRES CAREFUL QUANTITATIVE ANALYSIS AND INTERPRETATION
limitations[0]the tagger's words
limitationsPET metabolic measures cannot yet be linked to patient outcome.
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
what this limits: any prognostic use of PET metabolism: AT PRESENT, THERE IS NO ESTABLISHED CORRELATION BETWEEN CEREBRAL METABOLIC RATES OF GLUCOSE OR OXYGEN AS MEASURED BY PET AND PATIENT OUTCOME
limitations[1]the tagger's words
limitationsThe minimally conscious state has almost no imaging evidence base yet.
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what this limits: any claim about the minimally conscious state: BECAUSE CRITERIA FOR THE MCS HAVE ONLY RECENTLY BEEN INTRODUCED, THERE ARE VERY FEW FUNCTIONAL IMAGING STUDIES OF PATIENTS IN THIS CONDITION
limitations[2]the tagger's words
limitationsThe central construct has no objective measure; its estimation is stated to require interpretation of clinical signs.
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what this limits: any consciousness determination in these patients as an objective measurement: the review states it cannot be measured by any machine and requires interpretation of clinical signs
limitations[3]1.0the tagger's words
limitationsThe criteria for brain death are stated to differ between countries, some requiring brainstem death only and others whole-brain death.
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what this limits: a brain-death determination as a jurisdiction-independent fact: the review states the diagnostic criteria differ from country to country
limitations[4]1.0the tagger's words
limitationsDiagnosis rests on inference from responses observed at the moment of examination, and misdiagnosis of these states is stated to be frequent.
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what this limits: a recorded diagnosis of VS, MCS or locked-in syndrome as settled: the review states misdiagnosis is frequent and assessment infers from responses at the time of examination
limitations[5]1.0the tagger's words
limitationsThe three sources of uncertainty are stated together in one sentence and compound each other: motor responses may be limited or inconsistent, consciousness is not all-or-none, and the assessment is an inference from responses observed at the moment of examination.
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
limitations[6]0.95the tagger's words
controlsstudies whose clinical detail was too thin to guarantee the accuracy of the diagnosis were excluded from the review
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eliminates: that the review's conclusions rest on cases whose diagnostic category - coma, vegetative state, minimally conscious - cannot be trusted · outcome (stated by the tagger, no quotation): held
controls[0]0.95the tagger's words
conceptsbrain death
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also in: brain death
concepts[0]the paper's words
conceptsminimally conscious state
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concepts[1]the paper's words
conceptsconsciousness
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also in: consciousness
concepts[2]the paper's words
sensesconsciousness - defined here for assessability rather than for correctness: as it can be assessed at the patient's bedside
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
senses[0]1.0the tagger's words
sensesconsciousness - explicitly not an all-or-none phenomenon, which is why bedside assessment is difficult
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
senses[1]1.0the tagger's words
sensesemergence from the minimally conscious state - defined by a capability: functional interactive communication or functional use of objects
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
senses[2]1.0the tagger's words
sensesbrain death - a category whose criteria are jurisdictional: brainstem death in some countries, whole-brain death in others, with the concept itself 'largely accepted' either way
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
senses[3]0.95the tagger's words
claim_relationsqualifies → the irreversible-neuronal-loss reading (ref. 64)
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differs in: WHETHER THE SAME METABOLIC IMPAIRMENT IS DAMAGE OR DYSFUNCTION - and the review states the disagreement rather than settling it: 'It is still controversial whether the observed metabolic impairment in this large cortical network reflects an IRREVERSIBLE STRUCTURAL NEURONAL LOSS, OR FUNCTIONAL AND POTENTIALLY REVERSIBLE DAMAGE.' The evidence offered against the first reading is a rare case class, not a test: 'However, in the rare cases where VS patients recover awareness ... PET SHOWS A FUNCTIONAL RECOVERY of metabolism in these same cortical regions'
claim_relations[0]0.9the tagger's words
claim_relationsbuilds-on → Andrews et al. 1996, Childs et al. 1993 and five others (refs. 1-7)
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differs in: WHAT THE MISDIAGNOSIS RATE IS EVIDENCE OF. The review cites seven misdiagnosis studies not as a finding about clinicians but as evidence that THE CATEGORY IS HARD TO APPLY AT THE BEDSIDE, and gives two reasons in the same passage: 'motor responses may be very limited or inconsistent', and 'consciousness is not an all-or-none phenomenon and its clinical assessment relies on inferences made from observed responses to external stimuli at the time of the examination'
claim_relations[1]0.95the tagger's words
content_tagsThe metabolic hallmark of the vegetative state is impaired metabolism in the polymodal associative cortices - bilateral prefrontal regions, Broca's area, parieto-temporal and posterior parietal areas, and precuneus.
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content_tags.findings[0]the tagger's words
content_tagsIntense noxious stimulation reached midbrain, contralateral thalamus and primary somatosensory cortex in every one of 15 vegetative patients, so primary sensory cortex remains reachable even when cortical evoked potentials are absent.
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content_tags.findings[1]the tagger's words
content_tagsThe same noxious stimulation failed to activate secondary somatosensory, insular, posterior parietal and anterior cingulate cortices in any vegetative patient, although all of these were activated in every control subject.
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content_tags.findings[2]the tagger's words
content_tagsThe precuneus and adjacent posterior cingulate cortex seem to be the regions that differentiate minimally conscious from vegetative patients.
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
content_tags.findings[3]the tagger's words
content_tagsPET showed significantly higher brain metabolic levels in locked-in than in vegetative patients.
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
content_tags.findings[4]the tagger's words
content_tagsThe lumped constant used to compute glucose metabolism from FDG-PET is not stable in damaged brains: it falls globally after traumatic brain injury and rises regionally in severe cerebral ischaemia, so absolute metabolic rates in these patients are unreliable.
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content_tags.findings[5]the tagger's words
content_tagsDespite the promise of functional neuroimaging, clinical examination and the nosological categories it establishes remain the standard for diagnosis and prognosis in these patients.
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
content_tags.findings[6]the tagger's words
content_tagsconsciousness
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
also in: consciousness
content_tags.definitions[0]the tagger's words
content_tagscoma
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
also in: coma
content_tags.definitions[1]the tagger's words
content_tagspersistent vegetative state
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
content_tags.definitions[2]the tagger's words
content_tagsminimally conscious state
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
content_tags.definitions[3]the tagger's words
content_tagslocked-in syndrome
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
content_tags.definitions[4]the tagger's words
content_tagshollow skull phenomenon
Quotation withheld — this record is not cleared for redistribution. The sentence is in the paper at the link above.
content_tags.definitions[5]the tagger's words
content_tags40-50% — overall cortical metabolism of vegetative patients as a proportion of normal values
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content_tags.quantities[0]the tagger's words
content_tags30-40% — brain metabolism in permanent vegetative state (12 months after trauma, 3 months after non-traumatic damage) as a proportion of normal values
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content_tags.quantities[1]the tagger's words
content_tags28% — lowest reported brain metabolism, measured under propofol anaesthesia, as a proportion of normal values
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content_tags.quantities[2]the tagger's words
content_tags40% — cortical cerebral metabolism during deep sleep (stages III-IV) as a proportion of normal values
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content_tags.quantities[3]the tagger's words
content_tags75% — cerebral metabolic rate for glucose, as a proportion of normal, in patients who recover from postanoxic coma
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content_tags.quantities[4]the tagger's words
content_tags15 — number of vegetative patients in whom noxious electrical stimulation activated midbrain, thalamus and primary somatosensory cortex
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content_tags.quantities[5]the tagger's words

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