Persistent vegetative state in Head injury

Abstract

Vegetative state is a clinical condition of complete unawareness of the self and the environment, accompanied by sleep-wake cycles, with either complete or partial preservation of hypothalamic and brain-stem autonomic functions. The clinical course and outcome of a persistent vegetative state depend on its cause. Post-traumatic unawareness persisting for more than a month should not be considered an irreversible condition, because an outcome that might be regarded by some as being acceptable is possible even in patients with very severe brain damage. Recovery of consciousness from a posttraumatic persistent vegetative state is unlikely after 12 months in adults and children. For most such patients, life expectancy ranges from 2 to 5 years; survival beyond 10 years is unusual. Corpus callosum and dorsolateral brainstem lesions are highly significant in predicting nonrecovery. Long-term prognosis of post-traumatic vegetative state (VS) remains poorly defined. Essential prognostic factors of VS include threat blink reflex presence, ventricular dilatation, brainstem and corpus callosal injury; motor score (Glasgow Coma Score) and presence of spontaneous eye movements.

Keywords

persistent vegetative state - diffuse axonal injury - outcome - severe head injury

• References

• 1 Anonymous. Medical aspects of persistent vegetative state (1). The Multi- Society task force on PVS. N Eng J Med 330 1994; 1499-1508
• 2 Anonymous. Medical aspects of the persistent vegetative state (2). The multi-Society Task Force on PVS (Published erratum appears in). N Eng J Med 333 1995; 130
• 3 Celesia GG. Persistent Vegetative state. Neurology 43 1993; 1457-1458
• 4 Kenard C, Illingworth R. Persistent Vegetative State. J Neurol Neurosurg Psychiat 59 1995; 347-355
• 5 Doughtery JH, Rawlinson DG, Levy DE. et al Hypoxicischaemic brain injury and vegetative state. Clinical and Neuropathologic correlation. Neurology 34 1998; 991-997
• 6 Grossman P, Hagel K. Posttraumatic apallic syndrome following head injury. Part I. Clinical characteristics. Disabil Rehabil 18 1996; 1-20
• 7 Jellinger IC, Seitelberger F. Protracted posttraumatic encephalopathy. Pathology, pathogenesis and clinical implication. J Neurol Sci 10 1970; 51-94
• 8 Child NC, Mercer WN, Child HW. Accuracy of diagnosis of persistent vegetative state. Neurology 43 1993; 1465-1467
• 9 Andrews K, Murphy L, Munday R. et al Misdiagnois of the vegetative state: retrospective study in a rehabilitation unit. BMJ 313 1996; 13-16
• 10 Jennett B, Teasdale G, Braakman R. et al Prognosis of patients with severe headinjury. Neurosurgery 04 1979; 283-289
• 11 Marshall LF, Gautille T, Klauber MR. et al The outcome of severe closed head injury. J Neurosurg 75 1991; 528-553
• 12 Heindl UT, Laub MC. Outcome of persistent vegetative state following hypoxic or traumatic brain injury in children or adolescents. Neuropediatrics 27 1996; 94-100
• 13 Wade TD. Misdiagnosis of the vegetative state: Persistent vegetative state should not be diagnosed until 12 months from onset of coma. BMJ 313 1996; 943-944
• 14 Kampfl A, Franz G, Aichner F. et al The persistent vegetative state after closed headinjury: Clinical magnetic resonance imaging findings in 42 patients. J Neurosurg 88 1998; 809-816
• 15 Kampfl A, Schmutzhard E, Franz G, Pfausler B, Haring HP, Ulmer H, Felber S, Golaszewski S, Aichner F. Prediction of recovery from post-traumatic vegetative state with cerebral MRI. Lancet 35 1998; 1763-1767
• 16 Dubroja I, Valent S, Miklic P, Kesak D. Outcome of posttraumatic unawareness persisting for more than a month. J Neurol Neurosurg Psychiatry 58 1995; 465-466
• 17 Kinney HC, Samuels MA. Neuropathology of persistent vegetative state. A review. J Neuropathol Exp Neurol 53 1994; 548-558
• 18 Kinney HC, Korein J, Panigraphy A. et al Neuropathological findings in the brain of Karen Ann Qumlan. The role of the thalamus and the persistent vegetative state. N Eng J Med 330 1994; 1469-1475
• 19 Peters G, Rothemund E. Neuropathology of traumatic apallic syndrome. In: Dalle Ove G, Gerstenbrand F, Lucking CH. (eds) The Apallic Syndrome. 1977. PV Springer-Verlag; Berlin: 78-87
• 20 Gentry LR, Thompson B, Godersky JC. Trauma to the corpus callosum: MR features. AJNR 09 1988; 1129-1138
• 21 Mendelsohn BD, Levis HS, Haward H. et al Corpus callosum lesions after closed headinjury in children. MRI, clinical features and outcome. Neuroradiology 34 1992; 384-388
• 22 Strich SJ. Diffuse degeneration of the cerebral white matter in severe dementia following head injury. J Neurol Neurosurg Psychiat 19 1956; 163-185
• 23 Adam JH, Doyle D, Ford I. et al Diffuse axonal injury in head injury: definition, diagnosis and grading. Histopathology 15 1989; 49-59
• 24 Levin HS, Saydijari C, Eisenberg HM. et al Vegetative state after closed head injury. A Traumatic Coma Tata Bank report. Arch Neurol 48 1991; 580-585
• 25 Gentry LR. Imaging of closed head injury. Radiology 191 1994; 1-17
• 26 Gentry LR, Godersky JC, Thompson BH. Traumatic brainstem injury: MR Imaging. Radiology 171 1989; 177-187
• 27 Reider-Groswasser I, Costeff HB, Sazbon L. et al CT findings in Persistent vegetative state following blunt traumatic brain injury. Brain Injury 11 1997; 865-870
• 28 Grossman P, Hagel K. Posttraumatic apallic syndrome following head injury, Part 2: Treatment. Disabil Rehabil 18 1996; 57-68
• 29 Kanno T. Neurostimulation for a case of unconsciousness of chronic stage. Brain and Nerve 47 1995; 643-649
• 30 Moriya T, Noda E, Sakurai J, et al. Neurological evaluation of unconscious patients with median nerve stimulation 8^th Annual meeting of the Society of Treatment of Coma. July 30, 1999
• 31 Yokoyama T, Kamei Y, Shoda M. et al Treatment of vegetative staus with Dorsal Column stimulation. Neurol Surg (Tokyo) 18 1990; 39-45
• 32 Moriya T, Hayashi A, Sakurai A, et al. Median nerve stimulation method for severe brain damage with its clinical improvement. In: Proceedings of the 8^th Annual meeting of Society of Treatment of coma. Hori S & Kanno T (eds) 1999 Page 111- 114.
• 33 Cooper JB, Jane JA, Alves WM. et al Right median nerve stimulation to hasten awakening from coma. Brain Injury 13 1999; 261-267
• 34 Matsui T, Fujiwara S, Takahashi H. et al Indication of electrical deep brain or dorsal column stimulation and new scoring system for prolonged impaired consciousness. J Neurosurg (Tokyo) 07 1998; 14-23
• 35 Yamamoto J, Fukuya t, Hiramaya T. et al Deep-brain and spinal stimulation therapy in PVS. Changes in PGD₂, PGE² and monoamine in CSF. Proceedings of 6th Annual meeting of Society of Treatment of Coma. 1993. Neuron Publishing Co.Ltd.; 6 63-70
• 36 Ueda K, Yanagida M. Effect of music on brain in the unconscious patients. Paper presented at 8^th Annual meeting of Society for Treatment of Coma. Beppu, Oita July 30, 1999.
• 37 Ijichi K, Tsutsu A, Maeda T, et al. Musical exercise therapy for patients with persistent disturbance of consciousness. Presented at the 8^th Annual meeting of the Society for treatment of coma. Beppu, Oita July 30, 1999.
• 38 Maeda T. Neural mechanism of sleep. Advances in Neurological Sciences (Tokyo) 39 1995; 7-15
• 39 Matsumura H. Prostaglandins and sleep. Advances in Neurological Science (Tokyo) 39 1995; 60-80
• 40 Di Rocco C. L dopa treatment of comatose state due to cerebral lesion. J. Neurosurg Sci 07 1974; 169-176
• 41 Yoshizawa T, Kikuechi H, Karasawa J. et al Bromocryptine treatment in patients with prolonged disturbances of consciousness and mentality. Shinryo to Shinnyaku 21 1984; 115-125
• 42 Saitosh H, Kurisu A, Shinohara Y. Effect of Bromocryptine on patients' with aphasia due to cerebrovascular disease. Shinkeinaikachiryo 08 1991; 543-547
• 43 Nishino K. Facilitated effect of L.dopa on recovery of prolonged consciousness disturbances and motor aphasia in a patient of cerebral stroke. Prog Med 18 1998; 1513-1520
• 44 Sitsu N. A computer assisted EEG study on Psychiatric properties of antiparkinsonian drugs. Seishin Shinkeigaku Zassi 94 1992; 238-262
• 45 Chrisostomo AD, Duncan PW, Propst MA. Evidence that amphetamine with physical therapy promotes recovery of motor function in stroke patients. Ann Neurol 23 1989; 94-97
• 46 Krimchansky BZ, Keren O, Sazbon L, Groswasser Z. Differential time and related appearance of signs, indicating improvement in the state of consciousness in vegetative state traumatic brain injury (VS-TBI) patients after initiation of dopamine treatment. Brain Inj 18 2004; 1099-1105