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Results for “Persistent Vegetative State”

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At least 1,117 records · Page 62Linked to original sources
PubMed1998

Assessment of brain perfusion in coma and comparison between SPECT and CT scan data: preliminary report.

In this study we submitted 24 comatose patients (Glasgow Coma Score <8) to Single Photon Emission Tomography (SPECT) during the clinical course of coma to verify its utility and the relationship between SPECT and CT scan data. SPECT was recorded following i.v. injection of Xe-133 in 17 patients and of Tc-99m-HMPAO or Tc-99m-ECD in the remaining 7. SPECT data recorded during the acute phase of coma did not show a clear correlation between cerebral blood flow (CBF) and outcome. SPECT and CT scan detected abnormalities in the same areas in 6 cases (25%); 6 patients (25%) with focal CT-scan lesions showed no focal CBF alterations in the same regions; conversely, in the remaining 12 cases (50%) SPECT disclosed severe perfusion abnormalities where no lesions were detectable on CT-scan. SPECT allowed us to recognize different regional flow patterns, such as absolute or relative hyperemia or oligoemia, which could not be checked with other means, thus improving patient's management. Apart from cerebral ischemia, there was no relationship between lesions on CT-scan and flow pattern. Our preliminary results suggest that SPECT can improve both the knowledge of patient's neurological conditions and management in comparison to the use of only CT scan.

Adolescent↗
PubMed2003

Feasibility of swallowing interventions for tracheostomized individuals with severely disordered consciousness following traumatic brain injury.

PRIMARY OBJECTIVE: To report the ability of 12 tracheostomized acute rehabilitation hospital inpatients with severely disordered consciousness post-traumatic brain injury (TBI) to participate in an objective swallowing assessment. RESEARCH DESIGN: Post hoc analysis of data from a larger, prospective blinded comparison study. METHODS AND PROCEDURES: Subjects completed a modified barium swallow (MBS) study. Food/drink and tracheostomy tube management recommendations were made. MAIN OUTCOMES AND RESULTS: All subjects participated successfully during an MBS. Post-MBS, 10 subjects began receiving small amounts of food and/or drink. Prior to hospital discharge, all subjects received some food and/or drink and were extubated. Subjects were deemed representative of this patient population and, from a swallowing perspective, other tracheostomized patient populations at the same facility. CONCLUSIONS: Clinicians should routinely consider tracheostomized, acute rehabilitation hospital inpatients with severely disordered consciousness post-TBI potential MBS candidates. Implications and continued research needs are discussed.

Adult↗
PubMed1998

Assessment after extremely severe head injury in a case of life or death: further support for McMillan.

This paper is a sequel to that of McMillan (1997) and describes further assessment of an extremely severely head injured patient. A combination of direct observations, structured interviews with staff, simple cognitive tests and questions with yes/no answers were used to assess communication and cognitive function in an extremely severely head injured patient with minimal ability to respond. Results confirmed the finding of McMillan and showed that the patient could understand and respond consistently to simple commands, could answer simple autobiographical questions consistently and clearly expressed her wish to live. The results of this study and that of McMillan confirm that valid assessment of minimally responsive patients is possible and that a number of different approaches are appropriate.

Awareness↗
PubMed2006

Aneurysm re-rupture during computed tomography angiography.

Re-rupture of cerebral aneurysms during conventional angiography, demonstrated by contrast leakage into the extravascular space, is well known and well documented. However, the occurrence of this complication during computed tomography (CT) angiographic examinations has rarely been published despite its extensive use. We present the clinical and radiological features of a rebleeding event during a CT angiographic study. No hemodynamic or contrast-related factors can be evoked predisposing to he occurrence of this complication during this imaging technique. This, along with the short study time, may explain the rarity of this coincidence.

Aneurysm, Ruptured↗
PubMed2004

Law and ethics.

Explore the source record for details and available documents.

Ethics, Medical↗
PubMed2006

What would Terri want? On the psychological challenges of surrogate decision making.

The Terri Schiavo case was unique in the media attention it garnered, but the decision making challenges faced by Terri's family are common ones encountered by all families who must make choices about the use of life-sustaining medical treatment for an incapacitated loved one. This article highlights three key issues that were particularly problematic in the Schiavo case, but that represent general psychological challenges inherent to the task of surrogate decision making. The 3 central points of uncertainty, and therefore conflict, in the Schiavo case concerned: (a) the appropriate standard by which medical decisions for Terri should be made, (b) the specific nature of Terri's wishes about the use of life-sustaining medical technology, and (c) the true extent of disability and prognosis for recovery represented by Terri's medical condition. No simple remedy is possible that will resolve all of the uncertainties inherent to surrogate decision making, but some general strategies for improving the quality of end-of-life medical decisions are discussed.

Adult↗
PubMed2006

Implications of the Schiavo case for understanding family caregiving issues at the end of life.

The case of Mrs. Terri Schiavo illustrates common themes in family caregiving at the end of life but is distinctive from most family caregiving situations in other ways. As occurred in Mrs. Schiavo's case, family members do act as both caregivers and decisionmakers for their loved ones at the end of life, often without the benefit of written advance directives. Family stress and conflict may result, yet seldom lead to court proceedings, legislative intervention, and media coverage as occurred in the Schiavo case. The importance of informal conflict resolution and the limitations of adversarial legal approaches are discussed.

Adult↗
PubMed2006

Extreme measures: a personal story of letting go.

The decision to withdraw life support from a loved one, especially in the absence of an advance directive, can be complicated and painful. This article is the author's personal account of her brother's brain injury, his resulting condition, and the choice made to allow his death. In addition, the author discusses how this experience affected her perspective on Terri Schiavo's death.

Adult↗