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Results for “Persistent Vegetative State”

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PubMed1999

Impaired effective cortical connectivity in vegetative state: preliminary investigation using PET.

Vegetative state (VS) is a condition of abolished awareness with persistence of arousal. Awareness is part of consciousness, which itself is thought to represent an emergent property of cerebral neural networks. Our hypothesis was that part of the neural correlate underlying VS is an altered connectivity, especially between the associative cortices. We assessed regional cerebral glucose metabolism (rCMRGlu) and effective cortical connectivity in four patients in VS by means of statistical parametric mapping and [18F]fluorodeoxyglucose-positron emission tomography. Our data showed a common pattern of impaired rCMRGlu in the prefrontal, premotor, and parietotemporal association areas and posterior cingulate cortex/precuneus in VS. In a next step, we demonstrated that in VS patients various prefrontal and premotor areas have in common that they are less tightly connected with the posterior cingulate cortex than in normal controls. These results provide a strong argument for an alteration of cortical connectivity in VS patients.

Adult↗
PubMed2000

[Approach to the patient in vegetative state. Part I: diagnosis].

Coma is the condition in which both components of consciousness, wakefulness and awareness, are lost. Therefore, the comatose patient neither opens the eyes, nor utters comprehensible words or follows commands. In the vegetative state (VS), awareness (including all cognitive function and emotion) is lost, while the vegetative functions, including breathing and sleep-wake cycles (the wakefulness), persist. Usually VS follows a state of coma caused by traumatic or anoxic brain damage. Pathologic brain examination demonstrates extensive subcortical, white matter, bilateral thalamic, and brainstem lesions in various combinations. Bilateral cerebral cortical lesions are rare, and therefore cortex can be "out of action" despite unaltered structure. More rarely, VS is caused by brain developmental malformations in children, or metabolic or degenerative diseases in children and adults. These are the only cases in which patients are not comatose before VS becomes apparent. After 6-8 weeks of coma, patients regain the eye opening. In such a condition, the term coma is no longer appropriate. If awareness is absent, the patient can be defined as in VS. Finally, the VS is defined as persistent (PVS) when it has continued for at least 1 month. The diagnosis of VS and PVS are clinical and require assessment over an adequate period of time and the skills of a multidisciplinary experienced team. Diagnosis is very complex in infants younger than 3 months, and is not applicable to preterm neonates, with the unique exception of infants with anencephaly. Among ancillary diagnostic tools, dynamic PET studies show promise.

Adult↗
PubMed2000

In the shadow of "death with dignity": medicine and cultural quandaries of the vegetative state.

In this paper I address one site of technological development and cultural production, the permanent or persistent comatose condition and the institutions and practices that enable this life form to exist. As with other medical sites of ambiguity and change under recent scrutiny by anthropologists, the locations in which comatose bodies thrive are those in which the routinization of technology use in the clinic and a legitimating social and economic context come together to permit and create a further remapping of the notions of "life" and "person." I explore the new forms of knowledge, practice, and the body that are created at this site and how they are negotiated, and I discuss how the shifting understanding of "culture" and "nature" both have an impact on and are informed by American quandaries about approaching death. I argue that beings who are neither fully alive, biologically dead, nor "naturally" self-regulating, yet who are sustained by modern medical practice, destabilize the existing social order in ways that are different from other hybrid forms.

Attitude of Health Personnel↗
PubMedDate not supplied

Rehabilitation interventions for vegetative and minimally conscious patients.

Brain injury rehabilitation is a complex and challenging task for all members of the multidisciplinary team. Medical advances have allowed more severely impaired patients to survive and consequently the number of patients in the vegetative and minimally conscious states have proportionately increased. Thus, the need for evidence-based practice and further research demonstrating the effects of specific rehabilitation interventions is required. This article reviews the current research and consensus on rehabilitation for patients in the vegetative and minimally conscious states.

Brain Injuries↗