phenomenon · claim-type · cross-domain-transfer · mechanism · claim-relation · replication-status · limitation — grounded in the full text| phenomenon | disorders of consciousness after severe brain damage— “We review the nosological criteria and functional neuroanatomical basis for brain death, coma, vegetative state, minimally conscious state and the locked-in state.” | |
| claim-type | mechanism— “Moreover, in the VS patients, the activated primary somatosensory cortex was shown to exist as an island, functionally disconnected from higher-order associative cortices of the pain-matrix.” | |
| method — evidence | — “References were selected on the basis of relevance and accessibility.” | |
| mechanism | progressive Wallerian and transsynaptic neuronal degeneration drives the further fall of brain metabolism as a vegetative state becomes permanent— “This progressive loss of metabolic functioning over time is the result of progressive Wallerian and transsynaptic neuronal degeneration.” | mechanisms[0] |
| mechanism | sparing of brainstem structures (pedunculopontine reticular formation, hypothalamus, basal forebrain) preserves arousal and autonomic function while the cortex is impaired, producing wakeful unawareness— “Characteristic of VS patients is a relative sparing of metabolism in the brainstem (encompassing the pedunculopontine reticular formation, the hypothalamus and the basal forebrain).62 The functional preservation of these structures allows for the preserved arousal and autonomic functions in these patients.” | mechanisms[1] |
| mechanism | 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— “Moreover, a cascade of functional disconnections were observed along the auditory cortical pathways, from primary auditory areas to multimodal and limbic areas,70 suggesting that the observed residual cortical processing in the VS does not lead to integrative processes which are thought to be necessary for awareness.” | mechanisms[2] |
| qualifies | the irreversible-neuronal-loss reading (ref. 64)— “It is still controversial whether 8 the observed metabolic impairment in this large cortical network reflects an irreversible structural neuronal loss,64 or functional and potentially reversible damage. However, in the rare cases where VS patients recover awareness of self and environment, PET shows a functional recovery of metabolism in… [checked against the archived source, not this rendering] | claim_relations[0] |
| builds-on | Andrews et al. 1996, Childs et al. 1993 and five others (refs. 1-7)— “This difficulty is reflected in the frequent misdiagnoses of VS, MCS and locked-in syndrome (LIS).1-7 Bedside evaluation of residual brain function in severely brain-damaged patients is difficult because motor responses may be very limited or inconsistent. In addition, consciousness is not an all-or-none phenomenon8 and its clinical… | claim_relations[1] |
| sense | consciousness - defined here for assessability rather than for correctness: as it can be assessed at the patient's bedside— “In the present review, we will first define consciousness as it can be assessed at the patient’s bedside.” | senses[0] |
| sense | consciousness - explicitly not an all-or-none phenomenon, which is why bedside assessment is difficult— “consciousness is not an all-or-none phenomenon” | senses[1] |
| sense | emergence from the minimally conscious state - defined by a capability: functional interactive communication or functional use of objects— “The emergence of MCS is defined by the ability to use functional interactive communication or functional use of objects.” | senses[2] |
| sense | brain 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— “Most countries have published recommendations for the diagnosis of brain death but the diagnostic criteria differ from country to country.15 Some rely on the death of the brainstem only,16 others require death of the whole brain” | senses[3] |
| control | studies whose clinical detail was too thin to guarantee the accuracy of the diagnosis were excluded from the review — held — rules out that the review's conclusions rest on cases whose diagnostic category - coma, vegetative state, minimally conscious - cannot be trusted— “We excluded certain studies in which clinical details provided were insufficient to guarantee accuracy of diagnoses.” | controls[0] |
| differs in | the irreversible-neuronal-loss reading (ref. 64) — 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'— “It is still controversial whether 8 the observed metabolic impairment in this large cortical network reflects an irreversible structural neuronal loss,64 or functional and potentially reversible damage. However, in the rare cases where VS patients recover awareness of self and environment, PET shows a functional recovery of metabolism in… [checked against the archived source, not this rendering]— “It is still controversial whether 8 the observed metabolic impairment in this large cortical network reflects an irreversible structural neuronal loss,64 or functional and potentially reversible damage” [checked against the archived source, not this rendering] | claim_relations[0] |
| differs in | Andrews et al. 1996, Childs et al. 1993 and five others (refs. 1-7) — 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'— “This difficulty is reflected in the frequent misdiagnoses of VS, MCS and locked-in syndrome (LIS).1-7 Bedside evaluation of residual brain function in severely brain-damaged patients is difficult because motor responses may be very limited or inconsistent. In addition… | claim_relations[1] |
| outcome (stated by the tagger, no quotation) | control — held | controls[0] |
| for which use | limitation — 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] |
| for which use | limitation — 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 Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | limitations[1] |
| for which use | limitation — 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 Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | limitations[2] |
| for which use | limitation — 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 Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | limitations[3] |
| for which use | limitation — a brain-death determination as a jurisdiction-independent fact: the review states the diagnostic criteria differ from country to country Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | limitations[4] |
| for which use | limitation — 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 Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | limitations[5] |
| replication | untested | |
| limitation | The imaging methods reviewed are hard to apply and interpret in this patient population. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | limitations[0] |
| limitation | PET metabolic measures cannot yet be linked to patient outcome. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | limitations[1] |
| limitation | The minimally conscious state has almost no imaging evidence base yet. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | limitations[2] |
| limitation | The central construct has no objective measure; its estimation is stated to require interpretation of clinical signs. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | limitations[3] |
| limitation | The criteria for brain death are stated to differ between countries, some requiring brainstem death only and others whole-brain death. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | limitations[4] |
| limitation | Diagnosis rests on inference from responses observed at the moment of examination, and misdiagnosis of these states is stated to be frequent. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | limitations[5] |
| limitation | The 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 paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | limitations[6] |
finding · quantity · variable · definition · key-term — grounded in the full text| finding | The 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. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.findings[0] |
| finding | Intense 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. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.findings[1] |
| finding | The 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. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.findings[2] |
| finding | The precuneus and adjacent posterior cingulate cortex seem to be the regions that differentiate minimally conscious from vegetative patients. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.findings[3] |
| finding | PET showed significantly higher brain metabolic levels in locked-in than in vegetative patients. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.findings[4] |
| finding | The 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. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.findings[5] |
| finding | Despite 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 paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.findings[6] |
| quantity | 40-50% — overall cortical metabolism of vegetative patients as a proportion of normal values Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.quantities[0] |
| quantity | 30-40% — brain metabolism in permanent vegetative state (12 months after trauma, 3 months after non-traumatic damage) as a proportion of normal values Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.quantities[1] |
| quantity | 28% — lowest reported brain metabolism, measured under propofol anaesthesia, as a proportion of normal values Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.quantities[2] |
| quantity | 40% — cortical cerebral metabolism during deep sleep (stages III-IV) as a proportion of normal values Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.quantities[3] |
| quantity | 75% — cerebral metabolic rate for glucose, as a proportion of normal, in patients who recover from postanoxic coma Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.quantities[4] |
| quantity | 15 — number of vegetative patients in whom noxious electrical stimulation activated midbrain, thalamus and primary somatosensory cortex Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.quantities[5] |
| definition | consciousness Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.definitions[0] |
| definition | coma Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.definitions[1] |
| definition | persistent vegetative state Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.definitions[2] |
| definition | minimally conscious state Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.definitions[3] |
| definition | locked-in syndrome Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.definitions[4] |
| definition | hollow skull phenomenon Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.definitions[5] |
| concept | brain death Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concepts[0] |
| concept | minimally conscious state Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concepts[1] |
| concept | consciousness Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concepts[2] |
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