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persistent vegetative state

Follows a period of coma [2] Etiology: - traumatic brain injury - anoxic brain injury (ischemic stroke) - hemorrhagic stroke [3] Pathology: - severe injury to the cerebral hemispheres - sufficiently intact diencephlon & brainstem to allow - autonomic function - motor reflexes - sleep-wake cycles [1] - may involve disconnection of the precuneus from sensory input [2] Clinical manifestations: 1) absence of cognitive function 2) preserved vegetative functions a) respiration b) blood pressure regulation c) sleep-wake cycles 3) may open eyes to external stimuli 4) may show spontaneous movement 5) patients do not speak, follow commands or exhibit reliable, reproducible evidence of meaningful interactions with their environment Special laboratory: - electroencephalography may be useful to detect intact awareness [4] Radiology: - functional magnetic resonance imaging may be useful to detect intact awareness [4] (expensive) Management: - diagnosis made after extended period of observation. - prognosis for a meaningful recovery is poor. - minimally conscious state retrospectively applied to rare individuals who do recover (in part) Clinical trials: - among 50 patients with persistent vegetative state (age range 14-83) after 2 years [3] - 21 patients died - 17 remained in persistent vegetative state - 5 evolved to minimally conscious state - 7 regained consciousness (with severe functional disability) - 12 patients with persistent vegetative state [3] - all either remained in persistent vegetative state or died

Related

arousal minimally conscious state

General

disorder of arousal; lack of awareness; impaired consciousness

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 16. American College of Physicians, Philadelphia 1998, 2012
  2. Silva S et al. Wakefulness and loss of awareness: Brain and brainstem interaction in the vegetative state. Neurology 2010 Jan 26; 74:313. PMID: 20101037
  3. Estraneo A et al. Late recovery after traumatic, anoxic, or hemorrhagic long- lasting vegetative state. Neurology 2010 Jul 20; 75:239 PMID: 20554941 - Luaute J et al. Long-term outcomes of chronic minimally conscious and vegetative states. Neurology 2010 Jul 20; 75:246. PMID: 20554940
  4. Cruse D et al. Bedside detection of awareness in the vegetative state: A cohort study. Lancet 2011 Nov 10 PMID: 22078855 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61224-5/fulltext
  5. Hirschberg R, Giacino JT. The vegetative and minimally conscious states: diagnosis, prognosis and treatment Neurol Clin. 2011;29(4):773-786 PMID: 22032660
  6. Thompson HJ, McCormick WC, Kagan SH. Traumatic brain injury in older adults: epidemiology, outcomes, and future implications. J Am Geriatr Soc. 2006;54:1590-1595 PMID: 17038079 PMCID: PMC2367127 Free PMC article
  7. NINDS Coma Information Page (includes persistent vegetative state) https://www.ninds.nih.gov/disorders/all-disorders/coma-information-page