Disambiguating Consciousness in Clinical Settings

Patients affected by severe brain injury can experience complex states of disordered consciousness. These include the comatose state, characterized by a complete loss of spontaneous or stimulus-induced wakefulness and awareness; the vegetative state/unresponsive wakefulness syndrome, in which patients can be awake but exhibit no signs of conscious perception or deliberate action; the minimally conscious state, characterized by low-level awareness of self or environment; and the acute confusional state, which entails the recovery of wakefulness and awareness with persistent confusion.1,2 Patients with acute brain injuries may move unpredictably between these states and often evade precise and accurate assessment due to limitations in assessment techniques and patient-specific factors masking expression of consciousness.3