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Results for “Persistent Vegetative State”

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PubMed1999

[The brain hypothermia therapy for prevention of vegetation after severe brain injury].

We have presented a new concept of brain hypoxia oriented brain hypothermia treatments. All severe brain injury patients (148 cases) were GCS < 6. The masking brain hypoxia by brain thermo pooling, catecholamine surge induced cardiac dysfunction and intestinal vasodilatation, reduction of Hb-2.3 diphosphoglyserate were major target of initial treatment. These specific brain hypoxia was only controlled by brain hypothermia (34-32 degrees C), oxygen delivery > 800 ml/min. and AT-III > 100%. 2. The brain hypothermia were very successful to prevent masking brain hypoxia, selective radical attack to A10 dopamine nervous system, and brain edema. However, metabolic shift to lipid metabolism and lower growth hormone related immune crisis were recorded as a negative factors. Clinical results were so advanced. The mortality were 44 in 148 cases (30%), good recovery were 59 in 148 cases (40%), mild disability were 20 in 148 cases (13%) and vegetate state were only 15 in 148 cases (10%). The combination of brain hypothermia and replacement of cerebral dopamine were very successful to prevent the vegetation in severe brain injury.

Adult↗
PubMed2004

A critical analysis of conceptual domains of the vegetative state: sorting fact from fancy.

Neurophysiological research on the vegetative state (VS) presupposes a clearly defined patient population. VS has been variously defined in three domains: anatomy, behavior, and consciousness. Research on each conceptual type of "VS" is reviewed. Certain key elements of official VS dogma are cast into doubt or flatly contradicted by recent noninvasive neurophysiological studies. "Behavioral VS" is often the manifestation of a multi-modular disconnection syndrome rather than the complete absence of cortical functioning. Some "behavioral VS" may represent a "super locked-in state," with some primitive awareness of self and environment, including the capacity to experience pain. The term VS should be dropped and replaced with one that reflects what is truly known and verifiable about the condition and the individual patient.

Cerebral Cortex↗
PubMed2005

Events and decision-making in the long-term care of Dutch nursing home patients in a vegetative state.

OBJECTIVE: To clarify characteristics of long-term care and treatment of patients in a vegetative state. DESIGN: Qualitative, descriptive study in a Dutch nursing home. METHODS: Review of clinical records of patients in a vegetative state after acute brain damage between 1978-2002. RESULTS: Five patients received intensive care of a multi-disciplinary team and showed considerable co-morbidity. There was no standard scenario for end-of-life decisions. Physicians play a more proactive role by evaluating the total medical treatment instead of withholding therapy in case of incidental complications. The families' attitude is a crucial factor in their ultimate decision. CONCLUSIONS: There is no standard solution to alleviate the fate of patients in a vegetative state and their families. Withdrawing all medical treatment, including artificial nutrition and hydration, can be an acceptable scenario for letting the patient die. More research is needed to identify the factors that contribute to acceptance of the physician's decision by the family.

Adolescent↗
PubMedDate not supplied

[Prognostic significance of neurophysiological parameters in nontraumatic apallic syndrome].

The time course of neurophysiological parameters (EEG, evoked potentials of various modalities, including P300, and polysomnography) was followed up in 10 patients with apallic syndrome (AS) of nontraumatic origin (heart arrest, stroke, neuroinfection, etc.) during the formation of the syndrome and the condition of various severity: incomplete formation of AS eventuating in gross psychoneurological defects and complete formation of AS (a stable vegetative state). A dynamic follow-up of not only EEG of awaken and sleeping patients, but of their evoked potentials, specifically somatosensory and P300, were shown to be significant for assessment of the course of AS and prediction of its outcome.

Adult↗
PubMed2006

Lack of association between the IL1A gene (-889) polymorphism and outcome after head injury.

BACKGROUND: Interleukin (IL) 1 is a proinflammatory cytokine that has been identified as an important mediator of neurodegeneration induced by ischemia or traumatic brain injury. Accumulating evidence to date has suggested that the major cytokine contributing to neurodegeneration after head injury is IL-1beta rather than IL-1alpha; however, there is no sufficient data regarding IL-1alpha in literature, and there may be an association between IL1A gene polymorphism and outcome after head injury. METHODS: We performed a prospective clinical study and included a recruited series of 71 patients who had head injury and were admitted to our neurosurgical unit. Severity of initial injury was assessed by the Glasgow Coma Scale. Outcome at 6 months after injury was assessed by means of the Glasgow Outcome Score. Interleukin 1alpha genotypes were determined from blood samples by standard methods. RESULTS: Of 40 patients with IL1A*2, 18 (45%) had an unfavorable outcome (dead, vegetative state, or severe disability) compared with 7 (22.5%) of 31 without IL1A*2 (P = .08). CONCLUSION: Our findings show that there is no genetic association between IL1A gene polymorphism and outcome after head injury. Further clinical studies should be designed to confirm and further evaluate these findings.

Adult↗
PubMed2004

Predictive value of sensory and cognitive evoked potentials for awakening from coma.

OBJECTIVES: To determine the prognostic role of late auditory (N100) and cognitive evoked potentials (MMN) for awakening in a cohort of comatose patients categorized by etiology. METHODS: The authors prospectively studied a series of 346 comatose patients. Coma was caused by stroke (n = 125), trauma (n = 96), anoxia (n = 64), complications of neurosurgery (n = 54), and encephalitis (n = 7). Patients were followed for 12 months and classified as awake or unawake. Univariate and multivariate analyses were performed using regression logistic and Cox models. RESULTS: Pupillary light reflex, N100, middle-latency auditory evoked potentials, age, and etiology were the most discriminating factors for awakening. Statistical analysis showed that pupillary reflex was the strongest prognostic variable for awakening (estimated probability 79.7%). The estimated probability of awakening rose to 87% when N100 was present and to 89.9% when middle-latency evoked potentials (MLAEPs) were present. It was 13.7% when pupillary reflex was absent in anoxic patients. When MMN was present, 88.6% of patients awakened. No patient in whom MMN was present became permanently vegetative. CONCLUSION: Pupillary reflex is the strongest prognostic variable, followed by N100 and MLAEPs allowing a reliable model for awakening. The presence of MMN is a predictor of awakening and precludes comatose patients from moving to a permanent vegetative state. Evaluation of primary sensory cortex and higher-order processes by middle-latency-, late, and cognitive evoked potentials should be performed in the prognosis for awakening in comatose patients.

Adolescent↗
PubMed2005

Angiographic and clinical results in 316 coil-treated basilar artery bifurcation aneurysms.

OBJECT: The aim of this study was to analyze the effect of the endovascular treatment of basilar artery (BA) bifurcation aneurysms and to compare the results with those published by other neuroendovascular teams. METHODS: The authors performed a retrospective analysis of 316 aneurysms of the BA bifurcation that had been treated using endovascular coil occlusion between November 6, 1992, and February 12, 2005. After the initial embolization procedure, a 90 to 100% occlusion rate was achieved in 86% of the aneurysms. No complication was evident in 80% of the lesions, although periprocedural aneurysm rupture (3.2%) and thromboembolic events (12.3%) were the most frequent complications. Clinical outcome according to the Glasgow Outcome Scale (GOS) was a score of 5 or 4 in 77%, 3 in 11%, 2 in 5%, and 1 in 7% of patients. Initial follow-up angiography studies were obtained in 56% of patients at a mean of 19 months posttreatment and demonstrated a 90 to 100% occlusion rate in 70%. No recurrence was seen on 65% of the aneurysms. Coil compaction was evident on 24% of the follow-up angiograms. A second treatment was performed on 48 aneurysms (15%) a mean of 27 months after the first therapeutic session and resulted in 90 to 100% occlusion in 83% of the lesions. Complications were encountered in 19% of the aneurysms. Rupture did not occur during any of the procedures. Clinical outcome was rated as GOS Score 5 or 4 in 83% of the patients and Grade 3 in 17%. During a cumulative clinical follow up of 821 years in 237 patients, 182 patients (81%) were independent (GOS Score 5 or 4), 33 (14%) were dependent (GOS Score 3), eight (3%) were in a vegetative state, and two (1%) had died. Clinical outcome was significantly worse after previous aneurysm rupture and following procedural complications. CONCLUSIONS: These results are within the range of published data for coil treatment of BA tip aneurysms and confirm both the safety and efficacy of this endovascular treatment method.

Aneurysm, Ruptured↗
PubMed2004

Reconsidering the dead donor rule: is it important that organ donors be dead?

The "dead donor rule" is increasingly under attack for several reasons. First, there has long been disagreement about whether there is a correct or coherent definition of "death." Second, it has long been clear that the concept and ascertainment of "brain death" is medically flawed. Third, the requirement stands in the way of improving organ supply by prohibiting organ removal from patients who have little to lose--e.g., infants with anencephaly--and from patients who ardently want to donate while still alive--e.g., patients in a permanent vegetative state. One argument against abandoning the dead donor rule has been that the rule is important to the general public. There is now data suggesting that this assumption also may be flawed. These findings add additional weight to proposals to abandon the dead donor rule so that organ supply can be expanded in a way that is consistent with traditional notions of ethics, law, public policy, and public opinion.

Anencephaly↗
PubMed2006

The vegetative state: a report of two cases with a long-term follow-up.

OBJECTIVES: To demonstrate that patients with Prolonged Vegetative State (PVS) can show signs of improvements and important changes and, consequently, to strengthen the necessity to evaluate them with long-term serial follow-ups. SETTING: Rehabilitation of patients with severe traumatic brain injury (TBI). PARTICIPANTS: Two people with severe TBI discharged after a long period of inpatient rehabilitation in a condition of PVS. RESULTS: After 5 years some important changes happened and the initial prognosis was proved to be wrong. CONCLUSION: Sometimes patients declared to be in PVS have the possibility to recover, especially when initial clinical conditions are particularly severe and do not allow the emergence of the state of consciousness. It is important to conduct regular follow-ups to better evaluate changes and, if it is necessary, to re-adjust the rehabilitation accordingly.

Adolescent↗
PubMedDate not supplied

Nutrition and hydration for the vegetative state and minimally conscious state patient.

This paper presents nutritional issues particular to patients in the vegetative state (VS) or minimally conscious state (MCS). It assumes that such patients would be tube fed and it examines suitable ways of assessing and monitoring their nutrition. It covers problems frequently encountered such as undernourishment, high fluid requirements, bowel management, and vomiting. It also looks at the practicalities of long-term tube feeding. Once medical stability has been achieved, feeding these patients is almost always successful with the patient's body weight restored to being within normal limits.

Body Mass Index↗
PubMed2004

Medical decision making in the vegetative state: withdrawal of nutrition and hydration.

Withdrawal of nutrition and hydration, is a difficult and sensitive issue for all those working with people in the vegetative state. There are arguments against the decision to withdraw any treatment that might result in the patient deteriorating or dying. These arguments include the view that all life is worth having, that we can never be certain that the patient is not aware, and concerns that there may be new scientific developments in the future from which the patient would benefit. Others argue that the patient has no interests in life; that it is undignified, if not an assault, to insert tubes into a permanently unconscious person; that very few people would want to survive in this condition; and that it prevents loves ones from grieving. These strongly held opposing views can make clinical decision making very difficult for the clinician. Once the decision has been made to withdraw treatment then the clinician has to be certain that the patient is in the vegetative state, that there are no factors preventing the patient demonstrating awareness, that he has received expert assessment and treatment, and that the prognosis for lack of recovery is as clear as it can be. It is important to support family and staff throughout this process. The concept of withdrawal of nutrition and hydration is a sensitive issue and clinicians can expect to be considered as not acting in the patient's best interest whatever decision is taken.

Decision Making↗
PubMed1996

Visually evoked cerebral blood flow velocity changes in different states of brain dysfunction.

BACKGROUND AND PURPOSE: By assessment of metabolically induced cerebral blood flow velocity changes, transcranial Doppler sonography offers the opportunity to evaluate vasoneuronal coupling in different states of brain activation and in critically ill patients. METHODS: With simultaneous transcranial Doppler monitoring of the posterior cerebral artery (PCA) and the middle cerebral artery (MCA), 27 control subjects, 11 patients under general anesthesia, 5 patients in the vegetative state, and 12 patients with aneurysmal subarachnoid hemorrhage were stimulated with a 10-Hz flashlight for 30 seconds. Ten cycles of stimulation were averaged, and a specific flow response (SFR) was computed as the normalized ratio of PCA/MCA mean flow velocity. RESULTS: Maximal SFR was 14.2% in control subjects. Eye closure significantly reduced maximal SFR (11.6% versus 15.4%, P<.01). In subarachnoid hemorrhage, SFR was markedly decreased in the early phase (4.8%, P<.01) but became normal later on. Four of 5 patients with abolished SFR suffered delayed ischemia due to vasospasm. Of 7 patients with preserved SFR, 5 had vasospasm but none had delayed ischemia. No SFR was observed in patients under general anesthesia or in the vegetative state. CONCLUSIONS: Although reflecting fast and local neuronal activity patterns, metabolically induced blood flow response is highly dependent on stimulus-directed attention. In subarachnoid hemorrhage, decreased metabolic flow response suggests severe depression of vasoneuronal coupling, and abolished SFR might indicate increased vulnerability to vasospasm and a higher risk for delayed ischemia.

Adult↗