Alterations of consciousness from Victor Horsley to Joseph Giacino

Abstract

States of alterations of consciousness have been known since antiquity, but references in scientific literature began to be published at the end of the 19th century. Establish the differences between these multiple states are a real scientific problem. Proper diagnosis will depend on the treatment and follow-up of patients. In this work the author performs a historical sketch since 1886 that Victor Horsley discusses the level of consciousness until the 2002 by Joseph Giaciono and his collaborators describe the state of minimal consciousness. The criteria for persistent vegetative state described by Brian Jennett and Freud Plum in 1972, as well as the criteria of minimal consciousness are established. The brain death as a cessation of all brain functions is conceptualized and are discussed the criteria established in Cuba for diagnosis. Other disorders of consciousness that are reviewed are coma, akinetic mutism and locked in syndrome. Differential diagnosis between different alterations of consciousness is established based on sleep-alert cycles, eye opening, motor function, auditory function, visual function and communication, also arises the time needed for diagnosis and neurological prognosis. It is considered that the modern discoveries of new neural correlates and residual cognitive functions have contributed to clarify important unknowns. It is concluded that, despite advances in the knowledge of the alterations of consciousness, these entities are now a real challenge for neuroscientists.