Vegetative States

Vegetative States

The vegetative state is a clinical syndrome in which cognitive function is lost, due to neocortical damage (hence no awareness, response, speech), while vegetative (autonomic, respiratory) function is preserved due to intact brainstem centres. Primitive postural and reflex limb movements may also be observed. The syndrome, also known as neocortical death, coma vigil, and the apallic syndrome, may be seen after extensive ischemic-hypoxic brain injury, for example following resuscitation after cardiac arrest, and needs to be distinguished from coma, akinetic mutism, and the locked-in syndrome. Persistent vegetative state (PVS) is defined by persistence of this state for > 12 months (UK) or > 6 months (USA) after brain trauma, or > 6 months (UK) or > 3 months (USA) following brain anoxia. The prognosis of PVS is poor, but occasional reports of very late recovery have appeared.

References

Jennett B. The vegetative state. Medical facts, ethical and legal dilem-mas. Cambridge: CUP, 2002
Wade DT, Johnston C. The permanent vegetative state: practical guidelines on diagnosis and management. British Medical Journal1999; 319: 841-844
Zeman A. The persistent vegetative state: conscious of nothing?
Practical Neurology 2002; 2: 214-217

Cross References

Akinetic mutism; Coma; Locked-in syndrome