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Results for “Persistent Vegetative State”

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PubMed1998

Necrosis and haemorrhage of the putamen in methanol poisoning shown on MRI.

Methanol, a highly toxic substance, is used as an industrial solvent and in automobile antifreeze. Acute methanol poisoning produces severe metabolic acidosis and serious neurologic sequelae. We describe a 50-year-old woman with accidental methanol intoxication who was in a vegetative state. MRI showed haemorrhagic necrosis of the putamina and oedema in the deep white matter.

Cerebral Hemorrhage↗
PubMedDate not supplied

Deep brain stimulation therapy for the vegetative state.

Twenty-one cases of a vegetative state (VS) caused by various kinds of brain damage were evaluated neurologically and electrophysiologically three months after brain injury. These cases were treated by deep brain stimulation (DBS) therapy, and followed up for over 10 years. The mesencephalic reticular formation was selected as a target in two cases, and the thalamic centre median-parafascicular (CM-pf) complex was selected as a target in the other 19 cases. Eight of the 21 patients emerged from the VS, and became able to obey verbal commands. However, they remained in a bedridden state except for one case. DBS therapy may be useful for allowing patients to emerge from a VS, if the candidates are selected according to appropriate neurophysiological criteria. A special neurorehabilitation system may be necessary for emergence from the bedridden state in the treatment of VS patients. Further, DBS therapy is expected to provide a useful method in minimally conscious state (MCS) patients to achieve consistent discernible behavioural evidence of consciousness, and emergence from the bedridden state.

Adult↗
PubMed1996

Constructing arousal profiles for vegetative state patients--a preliminary report.

Arousal profiles are a method that we have developed for using data derived from time sampling to examine how behaviours such as the frequency with which the eyes are observed open, and the frequency of spontaneous movements, vary in the periods immediately before and immediately after sensory stimulation treatment. We believe changes in such behaviours reflect changes in arousal. The use of this new technique is illustrated with examples from a pilot study using data from 15-day treatment blocks, gathered for 10-minute periods immediately before and after sensory stimulation treatment from three patients using single-case research methods. The patients were diagnosed as being in vegetative state following traumatic brain injury. The possible significance of the differing characteristics of the profiles is discussed.

Adult↗
PubMed2005

Neurometabolic coupling in the vegetative and minimally conscious states: preliminary findings.

The objective of this study was to determine the integrity of the homoeostatic coupling relationship between neuronal electrical function and cerebral metabolism in the vegetative and minimally conscious states. Ten patients who met recognised diagnostic criteria (six in the vegetative state and four minimally conscious) were investigated using simultaneous electroencephalography and positron emission tomography. It was found that the coupling between neuronal electrical activity and regional glucose metabolism was preserved in all the minimally conscious patients but was absent in all the vegetative state patients. Our preliminary results suggest patients in the vegetative state may endure an impaired coupling relation between neuronal electrical function and cerebral energy metabolism.

Adult↗
PubMedDate not supplied

Diffusion-weighted imaging in the setting of diffuse cortical laminar necrosis and hypoxic-ischemic encephalopathy.

BACKGROUND AND PURPOSE: As is the case for CT scans, MR images may occasionally appear deceptively normal unless proper windowing is used. We sought to illustrate the necessity for proper windowing and for assessing the gray-white matter differentiation on diffusion-weighted (DW) images in the setting of hypoxic-ischemic encephalopathy. METHODS: Six comatose patients (age range, 34-56 years) underwent MR imaging in the early phase (range, 1-5 days) after severe anoxic insult. T2-weighted, turbo fluid-attenuated inversion-recovery, and DW images were obtained in all six patients, with contrast-enhanced T1-weighted images obtained in four and apparent diffusion coefficient (ADC) maps in five of the six patients. RESULTS: At presentation, each of the six patients had symmetric, uniform hyperintensity in the cortex (mean ADC, 0.35 x 10(-3) mm(2)/s) relative to the white matter (mean ADC, 0.91 x 10(-3) mm(2)/s) on DW images. Each also had a poor outcome: brain death in four patients and a permanent vegetative state in two patients. CONCLUSION: The appearance of the MR images in the setting of diffuse cortical laminar necrosis can be deceptive to the unwary radiologist. The key to correct interpretation is proper windowing and the marked gray-white matter differentiation on spin-echo images but best seen on properly windowed DW images in the early subacute phase. This appearance also implies an extremely poor outcome, either a permanent vegetative state or brain death.

Adult↗
PubMed2003

Medical aspects of the minimally conscious state in children.

The minimally conscious state is a condition of severely altered consciousness in which minimal but definite behavioral evidence of self or environmental awareness is demonstrated. This must be established on a reproducible or sustained basis by one or more of four types of behaviors including simple command-following, gestural or verbal 'yes/no' responses, intelligible verbalizations, or purposeful behaviors. The minimally conscious state can occur in children and usually is due to acquired brain injuries (traumatic and non-traumatic), central nervous system degenerative and neurometabolic disorders or congenital or developmental disorders. It is assumed that the lower limit of the minimally conscious state occurs when patients emerge from a vegetative state. What remains uncertain is how we can assess the upper limits, that is the degree of improvement that indicates that an individual is no longer minimally conscious. It also is unknown if, when and to what extent children can emerge from a minimally conscious state and whether their prognosis is better than children who are vegetative. It is assumed that the minimally conscious state may become 'permanent' 12 months after traumatic brain injury and 3 months after non-traumatic injury although there have been no studies that have examined this issue. Medical and rehabilitative treatment of children in a minimally conscious state should be provided to maintain comfort, reduce complications, and optimize functional recovery.

Adolescent↗
PubMed2005

The minimally conscious state: defining the borders of consciousness.

There is no agreement as to where the limits of consciousness lie, or even if these putative borders exist. Problems inherent to the study of consciousness continue to confound efforts to establish a universally accepted theory of consciousness. Consequently, clinical definitions of consciousness and unconsciousness are unavoidably arbitrary. Recently, a condition of severely altered consciousness has been described, which characterizes the borderzone between the vegetative state and so-called "normal" consciousness. This condition, referred to as the minimally conscious state (MCS), is distinguished from the vegetative state by the presence of minimal but clearly discernible behavioral evidence of self or environmental awareness. This chapter reviews the diagnostic criteria, pathophysiology, prognostic relevance, neurobehavioral assessment procedures and treatment implications associated with MCS.

Brain↗
PubMed2001

Severe traumatic brain injury from unmotorized scooter.

The popularity and use of unmotorized, foot-propelled scooters has risen dramatically in the last few years. Increasing reports of traumatic injuries from these scooters have paralleled their commercial sales and success in this country and worldwide. We report a case of a previously healthy 48-year-old woman who suffered a severe traumatic brain injury while riding one of these scooters, resulting in a devastating neurologic outcome and permanent vegetative state. This case emphasizes the importance of public awareness regarding the potential dangers and the need for appropriate precautions and protective gear when riding these recreational devices.

Accidents↗
PubMed2003

Spontaneous intracerebral hemorrhage and multiple infarction in Williams-Beuren syndrome.

A 7-year-old boy diagnosed with Williams-Beuren syndrome was admitted for spontaneous right hemispheric intracerebral hemorrhage. Cerebral angiography did not reveal any source of bleeding. After a short period of clinical improvement under conservative treatment, the boy deteriorated rapidly. CT showed the beginning of a complete infarction of both hemispheres. Operative evacuation of the bleeding and bilateral osteoclastic decompression had no perceptible influence on the clinical course. To the present day, the boy has remained in a vegetative state. Reports in the literature suggest that Williams syndrome with cerebral infarction is associated with a markedly poorer prognosis when there is additional intracerebral bleeding.

Cerebral Angiography↗
PubMed2004

The Sensory Modality Assessment and Rehabilitation Technique (SMART): a valid and reliable assessment for vegetative state and minimally conscious state patients.

PRIMARY OBJECTIVE: To establish the reliability and validity of the Sensory Modality Assessment and Rehabilitation Technique (SMART) as a tool for discriminating awareness in patients with profound brain damage. RESEARCH DESIGN: A comparative prospective study was conducted. METHOD AND PROCEDURES: Sixty subjects diagnosed in vegetative state (VS) on admission were assessed at 2-monthly intervals. Rancho level ratings derived from referring physicians, SMART and Western Neuro Sensory Stimulation Profile (WNSSP) scores were compared. MAIN OUTCOMES AND RESULTS: The intra-observer intra class correlation (ICC) was 0.97 and inter-observer ICC was 0.96, implying very little within and between observer scoring variations. A modest, although significant correlation was established between SMART and either physician or WNSSP scores. However, the correlation between the WNSSP and SMART was higher (r = 0.70) than that between WNSSP and physicians scores (r = 0.451) or between SMART and physicians (r= 0.474). CONCLUSION: SMART is a valid and reliable assessment for discriminating awareness in VS and Minimally Conscious State (MCS).

Adolescent↗