SERIES EDITOR
Sid Gilman, MD, FRCP
William J. Herdman Distinguished University Professor of Neurology
University of Michigan
Contemporary Neurology Series
53 SLEEP MEDICINE
Michael S. Aldrich, MD
54 BRAIN TUMORS
Harry S. Greenberg, MD, William
F. Chandler, MD, and Howard M.
Sandler, MD
56 MYASTHENIA GRAVIS AND
MYASTHENIC DISORDERS
Andrew G. Engel, MD, Editor
57 NEUROGENETICS
Stefan-M. Pulst, MD, Dr. Med., Editor
58 DISEASES OF THE SPINE
AND SPINAL CORD
Thomas N. Byrne, MD, Edward C.
Benzel, MD, and Stephen G.
Waxman, MD, PhD
59 DIAGNOSIS AND MANAGEMENT OF
PERIPHERAL NERVE DISORDERS
Jerry R. Mendell, MD, John T. Kissel, MD,
and David R. Cornblath, MD
60 THE NEUROLOGY OF VISION
Jonathan D. Trobe, MD
61 HIV NEUROLOGY
Bruce James Brew, MBBS, MD, FRACP
62 ISCHEMIC CEREBROVASCULAR
DISEASE
Harold P. Adams, Jr., MD, Vladimir
Hachinski, MD, and John W. Norris, MD
63 CLINICAL NEUROPHYSIOLOGY OF
THE VESTIBULAR SYSTEM, Third Edition
Robert W. Baloh, MD, and Vicente
Honrubia, MD
64 NEUROLOGICAL COMPLICATIONS OF
CRITICAL ILLNESS, Second Edition
Eelco F.M. Wijdicks, MD, PhD, FACP
65 MIGRAINE: MANIFESTATIONS,
PATHOGENESIS, AND MANAGEMENT,
Second Edition
Robert A. Davidoff, MD
66 CLINICAL NEUROPHYSIOLOGY,
Second Edition
Jasper R. Daube, MD, Editor
67 THE CLINICAL SCIENCE OF
NEUROLOGIC REHABILITATION,
Second Edition
Bruce H. Dobkin, MD
68 NEUROLOGY OF COGNITIVE AND
BEHAVIORAL DISORDERS
Orrin Devinsky, MD, and Mark
D’Esposito, MD
69 PALLIATIVE CARE IN NEUROLOGY
Raymond Voltz, MD, James L. Bernat, MD,
Gian Domenico Borasio, MD, DipPallMed,
Ian Maddocks, MD, David Oliver, FRCGP,
and Russell K. Portenoy, MD
70 THE NEUROLOGY OF EYE
MOVEMENTS, Fourth Edition
R. John Leigh, MD, FRCP, and
David S. Zee, MD
PLUM AND POSNER’S DIAGNOSIS
OF STUPOR AND COMA
Fourth Edition
Jerome B. Posner, MD
George C. Cotzias Chair of Neuro-oncology
Evelyn Frew American Cancer Society Clinical Research Professor
Memorial Sloan-Kettering Cancer Center
New York, NY
Clifford B. Saper, MD, PhD
James Jackson Putnam Professor of Neurology and Neuroscience,
Harvard Medical School
Chairman, Department of Neurology
Beth Israel Deaconess Medical Center
Boston, MA
Nicholas D. Schiff, MD
Associate Professor of Neurology and Neuroscience
Department of Neurology and Neuroscience
Weill Cornell Medical College
New York, NY
Fred Plum, MD
University Professor Emeritus
Department of Neurology and Neuroscience
Weill Cornell Medical College
New York, NY
1
2007
1
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Copyright # 2007 by Oxford University Press, Inc.
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Library of Congress Cataloging-in-Publication Data
Plum and Posner’s diagnosis of stupor and coma / Jerome B. Posner . . . [et al.]. — 4th ed.
p. ; cm.—(Contemporary neurology series ; 71)
Rev. ed. of: The diagnosis of stupor and coma / Fred Plum, Jerome B. Posner. 3rd ed. c1980.
Includes bibliographical references and index.
ISBN 978-0-19-532131-9
1. Coma—Diagnosis. 2. Stupor—Diagnosis. I. Posner, Jerome B., 1932– II. Plum, Fred, 1924–
Diagnosis of stupor and coma. III. Title: Diagnosis of stupor and coma. IV. Series.
[DNLM: 1. Coma—diagnosis. 2. Stupor—diagnosis. 3. Brain Diseases—diagnosis.
4. Brain Injuries—diagnosis.
W1 CO769N v.71 2007 / WB 182 P7335 2007]
RB150.C6P55 2007
616.8'49—dc22
2006103219
9 8 7 6 5 4 3 2 1
Printed in the United States of America
on acid-free paper
Jerome Posner, Clifford Saper and Nicholas Schiff dedicate this book to
Fred Plum, our mentor. His pioneering studies into coma and its
pathophysiology made the first edition of this book possible and
have contributed to all of the subsequent editions, including this one.
His insistence on excellence, although often hard to attain, has been
an inspiration and a guide for our careers.
The authors also dedicate this book to our wives, whose encouragement
and support make our work not only possible but also pleasant.