NEUROLOGY OF TERMINAL STATES

The paper gives a theoretical justification of CNS abnormality develop ing in patients who have a history of critical and terminal states, in cluding clinical death. The most significant abnormality is that which is termed posthypoxic and/or postresuscitation encephalopathies whose nature has not been elucidated particularly at the cellular and molec ular levels. It is emphasized that this involves brain abnormalities, which is a sequela of hypoxia or ischemia of systemic origin, rather t han primary brain damages. In some patients who have sustained a sever e hypoxic episode of any nature and recovered their psychoneurological status evern rapidly and rather fully, there may be an abrupt progres sive deterioration of their neurological status. in some days or month s, which results in death or grave irreversible disability. It is conc luded that not only do reparative and compensatory processes occur, bu t also there are phenomena of progressive degenerative changes in a pr imarily successfully resuscitated person or experimental animal in the central nervous system in the postresuscitation period. A classificat ion of psychoneurological disorders in patients in the early postresus citation period has been made and ways of their prevention or alleviat ion have been indicated.