[Course and outcome of severe traumatic coma].

This study will consider the course and final outcome of severe traumatic coma (Glasgow coma scale score 5-3 at admission). Intensive rehabilitation programs aimed at functional recovery must be undertaken from the very beginning. The importance of retraining of axial motricity is stressed. Successive stages of evolution and various neurological syndromes disclosed during the awakening period are described. Even in the case of these very severe brain injuries, a considerable amount of recovery is possible and leads to a normal socio-economic status in 62% of the cases. 22% however will remain bound to some type of sheltered life. Functional outcome is not related to the depth of initial coma but rather to the length of comatose period. It can be safely predicted only at the awakening phase, the neurological status reached at this time reflecting rather well the overall extent and severity of brain lesions. Neurophysiological mechanisms likely to support the functional recovery after this type of trauma are discussed.