The Apallic Syndrome

The subject of the apallic syndrome is one which has long been familiar to me, although I have not personally studied it as deeply as I would have wished. I became acquainted with this syndrome long before the last war, when my neurosurgical colleague Hugh Cairns (1952), made his pioneer contribution under the term "akinetic mutism" . This was an ar resting title, but it was one which did not altogether satisfy some of his colleagues, includ ing myself. We found it difficult to suggest an alternative. That is one reason why I wel come the expression "apallic syndrome" . Forensic practice has forced me from time to time to consider rather more deeply this distressing syndrome, and to try and marshal my ideas in a form which would satisfy my colleagues in the legal profession. More than once I have been instructed to make a medico legal assessment of these unfortunate patients. The points which have concerned my lawyer friends have not been matters of diagnosis, or of morbid anatomy, or of etiology. The fac tual problem which has been put before me was to make some approximate assessment as to the expectation of life. Vague guess-work is unacceptable in such circumstances. What the lawyers require is a precise and dogmatic answer.

Inhalt
I. Das apallische Syndrom.- Das apallische Syndrom..- II. Clinical Problems.- 1. Clinical Picture and Problems in Terminology..- 2. The Symptomatology of the Apallic Syndrome..- 3. The Transition Stage from Midbrain-Syndrome to Traumatic Apallic Syndrome..- 4. Surgery of Traumatic Apallic Syndrome..- 5. The Apallic Syndrome in Metabolic Disorders of the Brain..- 6. Apallic Syndrome Following Protracted Hypoglycemia..- 7. Apallic Syndrome in the Metabolic Diseases..- 8. Apallic Syndrome Due to Pharmacotoxic Effects..- 9. Courses of Protracted States of Coma..- 10. Apallic Syndrome in Diseases of the Cerebral White Matter..- 11. Psychopathology of the Apallic Syndrome..- 12. On the Psychopathology of Postapallic Terminal States..- III. Pathology.- 13. Neuropathology of the Traumatic Apallic Syndrome..- 14. Pathology and Pathogenesis of Apallic Syndromes Following Closed Head Injuries..- 15. Pathomorphological Aspects of the Nontraumatic Apallic Syndrome and of the Problem of Traumatic Brainstem Lesions with a Survival of Several Decades..- 16. Neuropathological Correlates of Supratentorial Lesions in Traumatic and Nontraumatic Apallic Syndrome..- IV. Pathophysiology.- 17. An Attempt at Interpretation of the Apallic Syndrome on the Basis of Experimental Findings..- 18. Experimental Studies with Cats to Produce a State Similar to the Apallic Syndrome..- 19. Clinical Pathophysiology of the Apallic Syndrome..- V. Additional Diagnostic Methods and Investigations.- 20. Temperature Regulation in Acute and Chronic Mesencephalic Syndrome and in Apallic Syndrome..- 21. A Neuroradiological Study of Traumatic Apallic Syndrome..- 22. Electroencephalographic Findings in the Apallic Syndrome..- 23. Studies on Sleep the Apallic Syndrome..- 24. Complementary Examinations of the Central Nervous System Activity in the Apallic Syndrome..- 25. Electronystagmographic Findings Following Traumatic Apallic Syndrome..- 26. Cerebral Blood Flow Reduction After Severe Head Injury and Its Relationship to the Extent of Brain Damage in Apallic Syndrome..- VI. Therapy.- 27. Early Treatment of the Initial Stage of the Apallic Syndrome..- 28. The Medical Therapy of the Apallic Syndrome.- 29. Problems of Tracheotomy in Patients with the Apallic Syndrome..- 30. Utilization of the Tonus Regulating Reflexes in the Rehabilitation of the Apallic Syndrome..- 31. The Rehabilitation of the Apallic Syndrome During the Phase of the Reintegration of the Higher Function Stages..- 32. The Rehabilitation of Patients with Apallic Syndrome in the Therapeutic Community..- 33. The Orthopedic Treatment of Patients with Apallic Syndrome..- 34. The Apallic Syndrome and Secondary Lesions of Peripheral Nerves..- 35. Social Problems of the Apallic Syndrome..- 36. A Rating Sheet to Monitor Apallic Syndrome Patients..