SEARCH · PubMed Health

Results for “Persistent Vegetative State”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 469 records · Page 26Linked to original sources

PubMed2003

Withdrawing life-sustaining medical treatment--a physician's personal reflection.

The decision to withhold or withdraw artificially provided hydration and nutrition is one which evolves over time and must be made jointly by the medical team and the patient's family. Although withholding nutrition can be argued to be ethical and appropriate for certain clinical scenarios, it is still a decision which can be difficult to make and, because of different social and legal issues, can be difficult to carry out. This is the story of one physician's journey as he worked with the mother and father of a young child who suffered a severe neurological injury and was left in a persistent vegetative state.

Child, Preschool↗

PubMed2002

Neurological and social long-term outcome after early rehabilitation following traumatic brain injury. 5-year report on 240 TBI patients.

The long term courses of patients after traumatic brain injury (TBI) are particularly influenced by the quality of neuropsychological rehabilitation and social reintegration. Though we do have data from different European countries about the success of surgery and intensive care, we don't know much about the long term courses, mirrored by the patients, their relatives and local physicians in their domestic environment. Supported by a pilot project of the government of Nordrhein--Westfalia we reviewed 252 patients with different grades of TBI, which were treated in our department from emergency to the end of early rehabilitation. At least 240 files could be completed, including observations up to 5 years after trauma (mean 26 months). 66% of the patients suffered from severe TBI according to the initial Glasgow Coma Scale (GCS), 23% showed moderate and 11% mild TBI. After discharge from early rehabilitation and during further treatment in rehabilitation hospitals patients with persistent vegetative state (PVS) did not show a significant benefit from therapy: Only 1 patient improved to GOS 3, fatal courses were observed in 3 patients, 11 patients remained unchanged. Patients with GOS 3 at the end of early rehabilitation on the other hand could improve in 51 cases to GOS 4 and 5. At the time of the actual investigation 32% of the patients reached GOS 5, 27% GOS 4. Unfavourable courses showed 21% (GOS 3), 5% (GOS 2) and 15% (GOS 1). Referred to the initial GCS only 16% of the severe, 27% of the moderate and 33% of the mild TBI could return to their former social activities and profession without any cuts. 145 of the total of surviving patients could return to their families, in the group of vegetative patients all except 1 patient were submitted for nursing homes. Only 58% of the patients practiced any kind of outpatient rehabilitation, a specialized neuropsychological training has been restricted to 7% of the patients. So we observe a significant gap between a high impact clinical medicine on one side and a deficient outpatient treatment on the other. At least many patients are standing alone after discharge from rehabilitation hospitals, resulting in prolonged stationary treatment with extensive costs to minimize damage from this situation. Our consequence for a more efficient treatment is, that we substantially need better programs by local administrations, insurance companies and employers for better and earlier reintegration to avoid isolation and unnecessary invalidation, especially of those patients with the best medical prognosis.

Adolescent↗

PubMed2000

Effect of intracerebral lesions detected in early MRI on outcome after acute brain injury.

In the present study we classified intracerebral lesions likely to influence the outcome of head injured patients according to localization, lesion type, lesion number and lesion volume. A score of intracerebral lesions based on findings in early MRI is presented. Early MRI studies were performed in 30 patients (average 5-6 days after trauma) and outcome (GOS) was determined after 3 and 12 months. Lesions were classified and lesion volume V was calculated (V = pi abc/6). The applied intracerebral lesion score included lesions in the frontal cortex, basal ganglia, corpus callosum and brainstem. Patients in a persistent vegetative state (PVS) showed a higher number (p = 0.018) and volume (p = 0.013) of frontal lesions as compared to the non-vegetative group (NPVS). Lesion volume in basal ganglia differed significantly between PVS and NPVS (p = 0.01) and correlated to outcome (r = -0.65, p < 0.005). Volume difference in the corpus callosum between PVS and NPVS was significant (p = 0.02). The number (r = -0.61, p < 0.005) and volume (r = -0.62, p < 0.005) of brainstem lesions correlated to outcome and PVS differed in number (p = 0.012) and volume (p = 0.006). The intracerebral lesion score correlated to the GOS (r = -0.57, p = 0.001) and PVS and NPVS differed significantly. A lesion volume exceeding 40 ml in the frontal cortex, 3.5 ml in the basal ganglia, 4 ml in the corpus callosum or 1.5 ml in the brainstem is likely to lead to an unfavorable outcome. More than 4 lesions in the frontal cortex or 3 lesions in the brainstem appeared more frequent in patients with unfavorable outcome. Treatment strategies in the early phase after brain injury could be modified by the knowledge of certain lesions only visible on MRI.

Brain↗

PubMed1987

Intracranial pressure following cardiopulmonary resuscitation.

Intracranial pressure (ICP) was measured in six patients following cardiopulmonary resuscitation (CPR). The causes of cardiac arrest were respiratory or circulatory problems and the primary intracranial pathology was not detected. The measurement of ICP started 3 to 10 h following CPR except one patient in whom it started on the day 7. Duration of ICP measurement ranged from 2 to 7 days. In five out of six patients, ICP persistently remained below 20 mmHg. In the remaining one patient, ICP elevation associated with seizure activity was observed and ICP ultimately increased to 57 mmHg. Among these, four patients died and two remained in a persistent vegetative state. These results suggest that ICP following CPR does not necessarily increase if the patient has no primary intracranial pathology or seizures.

Adult↗

PubMed1995

Pediatric cerebellar hemorrhages.

Cerebellar hemorrhage is a devastating condition with morbidity and mortality related not only to the etiology of the hemorrhage, but also to the timing of the intervention. Sixteen consecutive pediatric patients with acute cerebellar hemorrhages are presented: 6 had vascular abnormalities, 3 had tumors, and 2 had hemorrhages of unknown etiology. Thirteen of the 16 patients survived with only 1 of the 13 having persistent vegetative state as a neurologic outcome. Six of 8 patients presenting in a moribund condition had good outcomes, and 3 of 4 patients presenting with fixed and dilated pupils also had good outcomes. Thus, in contrast to adults, rapid evaluation by CT scanning, followed by the judicious use of ventricular drainage and prompt surgical treatment, have resulted in favorable outcomes in pediatric patients despite their poor clinical presentations. None of the neonates having cerebellar hemorrhages required surgical intervention; their courses could be followed clinically and with transfontanel ultrasound.

Adolescent↗

PubMed1985

Acute traumatic intraventricular hemorrhage in children.

Four cases are reported of acute traumatic intraventricular hemorrhage in children revealed by computed tomography (CT). In most cases, the intraventricular hemorrhage had been produced by severe sagittal impact. All of the children were 7 or less on the Glasgow Coma Scale (GCS) on admission. Three had hemorrhage in all ventricles, and one had an intraventricular hemorrhage in the lateral and fourth ventricles. One of them showed enhancement of the blood-filled ventricles, with the appearance of increased ventricular size, on the contrast enhancement CT. Two children with ventricular dilation died soon after injury, although ventricular drainage had been performed; one child remained in a persistent vegetative state, and the other enjoyed good recovery with conservative therapy. Certain features of acute traumatic intraventricular hemorrhage in children are discussed in relation to this series.

Brain Concussion↗

PubMed1994

Clinical significance of the finding of subarachnoid blood on CT scan after head injury.

The population analysed consisted of 268 out of 819 patients of a European nimodipine multicentre trial on severe head injury, whose first CT scan after injury showed signs of subarachnoid bleeding. The study demonstrated the importance of traumatic subarachnoid haemorrhage (tSAH) per se as a prognostic factor. The outcome of patients with tSAH is significantly worse than that of patients whose first CT does not show subarachnoid blood (noSAH). The outcome was unfavourable (dead, persistent vegetative state, severe disability) in 60% of tSAH patients compared to 30% of noSAH patients (p < 0.001). The difference in mortality was 42% vs. 14% (p < 0.001). The six month follow-up of tSAH patients complying with the study protocol and treated with intravenous nimodipine, 2 mg per hour for 7 days, showed a statistically significant reduction of unfavourable outcome from 66% to 51% (p < 0.05), compared to placebo treated patients.

Adult↗

PubMed1984

Review of 1,000 consecutive cases of severe head injury treated before the advent of CT scanning.

This is a review of 1,000 consecutive cases of severe head injury admitted to our Neurosurgical Department between January 1973 and August 1976, before the advent of CT scanning. All patients were comatose following head injury (GCS less than or equal to 8) and were treated homogeneously by the same neurosurgical team by a protocol that included immediate resuscitation on arrival, diagnosis of intracranial lesions by angiography, early surgery when needed, mechanical ventilation, steroids, and mannitol. Extracranial lesions, even if preponderant, were treated by various specialists in the Neurosurgical Department, which for all practical purposes operated as an Emergency Department. Admission criteria were very broad with no preadmission selection. The overall mortality for this series was 45%. A little less than half the patients made good recoveries or remained moderately disabled (47%); 6% were severely disabled, and 2% survived in a persistent vegetative state. More than two-thirds of the patients were brought to our Neurosurgical Department after a short stay at a general hospital; 72% were admitted within 6 hours of injury; 71% were traffic accident victims; and 34% had significant associated extracranial injuries. Carotid angiography was performed in 78% of the patients and indicated the presence of an intracranial haematoma requiring surgery in 36% of the whole series. Mortality was significantly higher in operated than in unoperated patients (56% versus 39%); those treated surgically, however, were older, in worse clinical condition, and showed a higher incidence of acute subdural haematomas associated with brain contusion. Carotid angiography proved very effective in revealing the presence of an expansive lesion but failed to reflect the severity of brain damage, since the group with "negative" angiograms showed a high mortality (52%). Patients with a lucid interval had a higher percentage of surgical lesions than those with immediate coma (58% versus 26%); but fully 42% of them did not require surgery, and 25% had negative angiograms. From the prognostic point of view the clinical data elicited after initial resuscitation were highly predictive of the outcome: some individual neurological signs, such as mydriasis, posturing and eye movements, were not inferior to the GCS score in that respect. Age also proved a strong predictor, since elderly patients are more likely to have severe subdural and parenchymal lesions and their clinical severity is accordingly greater.(ABSTRACT TRUNCATED AT 400 WORDS)

Accidents, Traffic↗

PubMed1998

99mTc-HMPAO SPECT in the diagnosis of brain death.

OBJECTIVE: To evaluate the effectiveness of single proton emission tomography (SPECT) with 99mTc-HMPAO in the diagnosis of brain death (BD). DESIGN: Prospective study in comatose and brain-dead patients. SETTING: Neurologic ICU. PATIENTS AND METHODS: Fifty comatose patients (age range: 10 days-75 years) were submitted to SPECT study. In 21 of them (42%) reversible factors (e.g., influence of drugs affecting the central nervous system) were present. Thirty-eight patients were clinically brain-dead, while the remaining 12 were tested both in pre-terminal conditions and after the clinical onset of BD. INTERVENTIONS: Brain SPECT following i.v. injection of 99mTc-HMPAO (300-1100 MBq), using a 4-headed gamma-camera (20 min, 360 degrees, 88 images). MEASUREMENTS AND RESULTS: All patients tested in pre-terminal conditions showed preserved brain perfusion. Two of them had flat EEGs despite the absence of any reversible cause of coma; three patients survived, but remained in persistent vegetative states. SPECT confirmed the diagnosis of BD in 45 out of 47 patients (95.7%), clearly showing the arrest of brain perfusion (picture of "empty skull"); in two clinically brain-dead children (aged 10 days and 12 months, respectively) weak perfusion of the basal ganglia, thalamus and/or brain stem was still present, precluding the diagnosis of BD; both of them died a few days later. CONCLUSIONS: Our results confirm the reliability of SPECT in the diagnosis of BD. A problem arises about its effectiveness in brain-dead children, but this seems to be a matter of definition of BD and cerebral viability, rather than a limit of SPECT.

Adolescent↗

PubMed2001

Mechanical ventilation in patients with acute ischemic stroke: survival and outcome at one year.

OBJECTIVE: To assess the prognosis of patients with acute ischemic stroke who require mechanical ventilation and to determine early factors influencing mortality. DESIGN: Prospective observational study. SETTING: Medical intensive care unit with a cerebrovascular emergency unit in a university-affiliated hospital. PATIENTS: Fifty-eight consecutive patients (mean age 65+/-13 years) requiring mechanical ventilation in the early course of an acute ischemic stroke. MEASUREMENTS AND RESULTS: Clinical data were recorded before intubation according to a standardized procedure. Mortality and functional outcome were assessed after a 1-year follow-up. Mechanical ventilation was started within 48 h after admission in 53 patients (91.4%). The mean duration of ventilation was similar in survivors (9.7+/-9.0 days) and non-survivors (8.6+/-8.7 days). Mortality was 72.4% at 1 year. Among the 16 survivors, none were in a persistent vegetative state and 11 had a Barthel index of 60, reflecting good functional status. Bilateral absence of corneal reflex and bilateral absence of pupillary light reflex had a positive predictive value of death of 1 (95% CI 0.78-1.00 and 0.74-1.00, respectively). After Cox regression analysis, presence of stupor or coma (OR 2.6, 95% CI 1.5-5.0), bilateral absence of corneal reflex before intubation (OR 3.4, 95% CI 1.4-8.7) and presence of ischemic cardiopathy (OR 2.8, 95% CI 1.4-5.5) were independent predictors of mortality. CONCLUSIONS: Systematic withholding of endotracheal intubation in patients with AIS is not recommended. Careful and rigorous neurologic examination, including assessment of brain stem reflexes, might help to identify patients with a very high probability of death despite mechanical ventilation.

Aged↗

PubMed2002

[Traction retinal detachment, optic atrophy, apallic syndrome after shaking trauma in an infant].

INTRODUCTION: Ophthalmological examinations are important in children with suspected shaken baby and/or battered child syndrome. Retinal and epiretinal haemorrhages can indicate non-accidental injuries. We observed a case of extensive retinal hemorrhages, edema of the optic disc followed by development of optic atrophy, neovascularisation and tractional retinal detachment over the course of months. CASE REPORT: A 6-week-old infant with no history of systemic disease or trauma was admitted to the children's hospital because of a disorder of consciousness, respiratory insufficiency, taut fontanel and dilated pupils with sluggish reaction to light. A subdural haematoma was diagnosed. Ophthalmological examination showed no signs of trauma in the anterior segment. Ophthalmoscopy revealed extensive retinal haemorrhages and swollen optic nerve heads. During the next months optic atrophy, subretinal fibrosis at the posterior pole, neovascularisation at the optic disc and non-rhegmatogenous retinal detachment developed. The child is in a persistent vegetative state. DISCUSSION: Non-accidental injuries can cause direct trauma and indirect traumatic sequelae. Retinal haemorrhages, especially in conjunction with unexplained trauma or changes of consciousness should arouse suspicion of shaken baby syndrome. The ophthalmologist should emphasize this and strongly recommend further investigation if not previously undertaken.

Battered Child Syndrome↗

PubMed2006

Vertebral artery dissections after chiropractic neck manipulation in Germany over three years.

Vertebral artery dissection (VAD) has been observed in association with chirotherapy of the neck. However, most publications describe only single case reports or a small number of cases. We analyzed data from neurological departments at university hospitals in Germany over a three year period of time of subjects with vertebral artery dissections associated with chiropractic neck manipulation. We conducted a country-wide survey at neurological departments of all medical schools to identify patients with VAD after chirotherapy followed by a standardized questionnaire for each patient. 36 patients (mean age 40 + 11 years) with VAD were identified in 13 neurological departments. Clinical symptoms consistent with VAD started in 55% of patients within 12 hours after neck manipulation. Diagnosis of VAD was established in most cases using digital subtraction angiography (DSA), magnetic resonance angiography (MRA) or duplex sonography. 90% of patients admitted to hospital showed focal neurological deficits and among these 11 % had a reduced level of consciousness. 50% of subjects were discharged after 20 +/- 14 hospital days with focal neurological deficits, 1 patient died and 1 was in a persistent vegetative state. Risk factors associated with artery dissections (e. g. fibromuscular dysplasia) were present in only 25% of subjects. In summary, we describe the clinical pattern of 36 patients with vertebral artery dissections and prior chiropractic neck manipulation.

Adult↗

PubMed1999

Stroke following chiropractic manipulation of the cervical spine.

We analyzed the clinical course and neuroradiological findings of ten patients aged 27-46 years, with ischemic stroke secondary to vertebral artery dissection (VAD; n = 8) or internal carotid artery dissection (CAD; n = 2), all following chiropractic manipulation of the cervical spine. The following observations were made: (a) All patients had uneventful medical histories, no or only mild vascular risk factors, and no predisposing vascular lesions. (b) VAD was unilateral in five patients and bilateral in three. VAD was located close to the atlantoaxial joint in all eight patients and showed additional involvement of lower sections in six, as well as temporary occlusion of one vertebral artery in three. (c) Nine of ten patients had brain infarction documented by magnetic resonance imaging or computed tomography. (d) Onset of symptoms was immediately after the manipulation (n = 5) or within 2 days (n = 5). (e) Progression of neurological deficits occurred within the following hours to a maximum of 3 weeks. (f) Maximum neurological deficits were severe in nine of ten patients. (g) Outcome after 4 weeks-3 years included no or mild neurological deficits in five patients, marked deficits in three, persistent locked-in syndrome in one, and persistent vegetative state in one. (h) Informed consent was obtained in only one of ten patients. Thus, patients at risk for stroke after chiropractic manipulation may not be identified a priori. Neurological deficits may be severely disabling and are potentially life threatening.

Adult↗

PubMed2005

Somatosensory evoked potentials in children with severe head trauma.

UNLABELLED: We evaluated the predictive value of somatosensory evoked potentials (SEP) in a series of children with severe traumatic brain injury (TBI). The prospective clinical investigation was performed in a Level I paediatric trauma centre. We included 26 consecutive comatose paediatric patients aged from 1 month to 17 years (median age 11 years) following severe TBI (initial Glasgow Coma Score (GCS) 8 or below). Besides SEP recordings, the intracranial pressure and the results of an initial cranial CT scan were filed. The Glasgow Outcome Scale (GOS) was used to assess outcome at discharge. Thirteen children had normal SEP measurements, three patients had abnormal SEP recordings and a cortical response was bilaterally absent in ten children. Out of 26 children, 10 died whereas two remained in a persistent vegetative state. Only one child suffered from significant neurological deficits (GOS 3) at discharge. Seven patients survived with a GOS of 4 and six children survived without neurological impairment (GOS 5). Normal SEP indicated a favourable outcome in most children but did not rule out the occurrence of death, while absence of SEP was related to unfavourable outcome in all cases. CONCLUSION: Measurement of somatosensory evoked potentials provides valuable data for determining the prognosis at early coma stages. Our data show that an unfavourable outcome can be predicted with higher precision than a favourable outcome.

Brain Injuries↗

PubMed2000

Introduction of GDC embolization in the clinical practice as treatment synergical to surgery: impact on overall outcome of patients with subarachnoid hemorrhage.

The GDC endovascular approach represent an effective alternative to surgery for treatment of intracranial aneurysms. Anyway no data are available about the impact of endovascular embolization with GDC on overall outcome of patients with subarachnoid hemorrhage. We analyse retrospectively a series of 234 patients admitted for ruptured intracranial aneurysm. Results were then compared with results of three surgical series from the literature. The 95.7% of patients underwent aneurysm treatment; 56.4% of patients were classified as good recovery, 12.8% presented moderate disability, 10.3% were severely disabled, 3% were in persistent vegetative state and 17.5% were dead. Patients older than 60 years accounted for 37% of all cases and good outcome in this group accounted for 54.7%. Good results were obtained in 90.1%, 61.7% and 22.8% of patients with Hunt-Hess grade I-II, III and IV-V respectively. Finally good outcome was observed in 82.8% of patients with aneurysms of the posterior circulation. Introduction of GDC embolization in clinical practice contributed to the extension of indication for aneurysm treatment leading to a reduction of overall mortality. GDC utilisation does not affect the overall percentage of patients with good outcome reflecting an increase of severely disabled patients. Endovascular treatment seems an effective theraputic choice in selected grade I-II patients. Results in grade III patients suggest that surgery may be advantageous because of washing and decompression of the basal cisterns while results in grade IV and V patients are unsatisfactory. GDC embolization clearly improves the prognosis of patients with posterior circulation aneurysms and probably is an advantageous theraputic choice in elderly patients.

Adolescent↗

PubMed2002

Basilar vasospasm following spontaneous and traumatic subarachnoid haemorrhage: clinical implications.

BACKGROUND: Cerebral vasospasm has been commonly described following subarachnoid haemorrhage (SAH) though its impact on neurological outcome, especially in head trauma, has not been yet elucidated. The purpose of this study was to monitor and correlate neurological condition and flow velocities (FVs) in the arteries of the brain after SAH and more particularly to investigate the influence of basilar artery (BA) vasospasm on neurological outcome. METHODS: Daily transcranial Doppler (TCD) evaluations were conducted in 116 consecutive patients with subarachnoid haemorrhage. SAH was of traumatic origin (tSAH) in 59 patients and spontaneous (sSAH) in 57 patients. Vasospasm in the MCA and ACA was defined by a mean FV exceeding 120 cm/s and three times the mean FV of the ipsilateral ICA. Basilar artery (BA) vasospasm was defined as moderate whenever the FV was higher than 60 cm/s and severe above 85 cm/s. FINDINGS: Sixty-two patients (53.4%) had elevated FVs in the BA, among these 34 (29.3%) had FVs above 85 cm/s. Basilar vasospasm was significantly more common in tSAH (59.7%) than in sSAH (40.3%, P=0.041). In patients with moderate and severe BA vasospasm, FVs in the BA increased on the third day after admission and remained elevated for a week before returning to normal value by the end of the second week. This elevation in BA FVs in patients with BA vasospasm was followed by a significant and progressive worsening in the neurological condition at the end of the first week. Permanent neurological deficit was associated with elevated BA FVs consistent with moderate BA vasospasm whereas patients who remained in persistent vegetative state, had FVs consistent with severe BA vasospasm (P=0.00019). INTERPRETATION: The present results further support that BA vasospasm may act as an independent factor of ischaemic brain damage following SAH, especially in head trauma.

Adolescent↗

PubMed1980

Neurologic outcome after emergency room thoracotomy for trauma.

The charts of 168 patients undergoing resuscitative thoracotomy for trauma in the emergency room at the San Francisco General Hospital from 1972 through 1978 were reviewed to assess factors affecting neurologic recovery after cardiac arrest. Forty-nine patients survived resuscitation and definitive operation, but 8 of them died in the first 24 hours postoperatively. Four patients in this group made some neurologic recovery (two good recoveries, two severe disabilities) but died later (12 to 44 days postoperatively) of septic complications. Thirteen nonsurvivors made no neurologic recovery before death. There were 33 long-term survivors (19.6 percent), 10 of whom were agonal or had no vital signs when first admitted to the emergency room. A persistent vegetative state developed in two patients who later died of sepsis (10 days and 14 months postoperatively). The remaining 32 patients all made good neurologic recovery that was apparent within 12 hours postoperatively. Transient amnesia was present during recovery in three patients. Wakefulness was the best prognostic sign of full neurologic recovery. In conclusion, emergency room thoracotomy can save a substantial number of moribund trauma patients who can be expected to sustain full neurologic recovery if they awaken within 12 hours.

Adolescent↗

PubMed1991

Predicting outcome in hypoxic-ischemic coma. A prospective clinical and electrophysiologic study.

A prospective analysis of 40 patients with hypoxic-ischemic coma lasting at least 6 h following sudden cardiac arrest was undertaken. The patients, all of whom had preserved brain-stem function, were studied electrophysiologically with electroencephalography (EEG), and median nerve somatosensory evoked potentials (SEPs) within 48 h to establish prognostic indices. Our results indicate that preserved brain-stem function does not necessarily predict favorable outcome following cardiac arrest as 26 of 40 (65%) patients died without awakening. The bilateral absence of cortical evoked potentials predicted death without awakening in 19 of 26 patients (73%) while malignant EEG change was similarly predictive in 11 patients (42%). Bilateral absence of cortical evoked potentials and/or malignant EEG change reliably predicted unfavorable outcome in 21/26 patients (81%). Patients with normal or delayed central conduction time (CCT) as well as 'benign' or 'uncertain' EEG findings had an uncertain prognosis as some entered a persistent vegetative state (PVS) or died without awakening. Fourteen patients (35%) awakened of whom 5 (13%) recovered completely while another 9 (23%) had varying degrees of motor or cognitive impairment. SEP and EEG findings did not distinguish between these outcomes.

Adult↗