Neuroimaging in disorders of consciousness: contributions to diagnosis and prognosis

10.2217/FNL.10.87 © 2011 Future Medicine Ltd The process of diagnosing a patient with a disorder of consciousness (DOC), such as the vegetative state (VS) or minimally conscious state (MCS), is a challenging one. Unlike other neurological conditions, these DOCs are not defined by a particular pathology or neural marker, but must instead be distinguished and diagnosed on the basis of clinical history and careful behavioral assessment. Such assessments typically rely on repeated daily examinations of spontaneous and elicited behavior in response to multisensory stimulation, in accordance with specific scales such as the Sensory Modality Assessment and Rehabilitation Technique (SMART) [1], the JFK Coma Recovery Scale – Revised (CRS-R) [2] or the Wessex Head Injury Matrix (WHIM) [3]. In all cases, a diagnosis of VS is only made when a state of ‘wakefulness without awareness’ [4] is observed, which in turn depends on three defining features [5]: