Coma is a state of acute and complete loss of consciousness induced by severe brain injury. Recently, a growing body of literature has enabled a better description of the pathophysiology of this state: new promising theoretical frameworks have been proposed to explain human conscious emergence and maintain, and innovative approaches has been developed to improve diagnosis and early prognostication in this clinically challenging setting ((Greer, Rosenthal and Wu 2014; Rossetti, Rabinstein and Oddo 2016; Menon and Maas 2015) ). It is worth noting that the whole of acquired pathological consciousness perturbation states, currently known as “disorders of consciousness” (DOC), constitutes a behavioural continuum, spanning from acute (e.g. coma) to chronic neurological syndromes (e.g. minimally conscious state, vegetative state). 

A structured, logical, and effective approach to manage these severely brain injured patients is required to:

• organize the support of vital function throughout the period of altered consciousness
  
• permit an early and efficiently treatment of primary brain injuries,
  
• prevent, detect and treat, secondary brain insults.
  

Careful clinical examination and patient’s medical history analysis are the cornerstones of DOC patient management. For example, during coma, determining whether the patient presents a focal sign or not play a crucial role during the stratification of the etiological work-up. Nevertheless, a thorough neurological examination may be difficult to perform in poorly cooperative DOC patients.