Vegetative And Minimally Conscious State

A vegetative state is characterized by the lack of responsiveness and attention as a result of a massive impairment of both cerebral hemispheres, but with sufficient residual function of the diencephalon and brain stem, in order to maintain an autonomous and motor reflexes and sleep-wake cycles. Patients can have complex reflexes, incl. Eye movements, yawning and involuntary movements to painful stimuli, but they show no awareness of themselves or their environment. A minimally conscious state is characterized as opposed to a vegetative state, by signs of a self-awareness or perception of the environment, and patients have a tendency to improvement. The diagnosis is made clinically. Treatment is mainly supportive. The prognosis for patients with persistent deficits typically desolate.

The vegetative Zutsand is a chronic phenomenon in which the ability to receive, maintain blood pressure, respiration and heart function, but not cognitive function. Hypothalamic functions and medullary brain stem functions remain intact to support cardiorespiratory and autonomic functions, and are sufficient for survival, provided the medical and nursing care is appropriate. The cortex is severely damaged (extinction of cognitive function), but the reticular Activate drying system (ARAS) remains functional (allows alertness). Midbrain or pontine reflexes may be present or absent. Patients have no self-awareness and interact with the environment only by reflexes. Seizure activity may be present but not clinically apparent.

A vegetative state is characterized by the lack of responsiveness and attention as a result of a massive impairment of both cerebral hemispheres, but with sufficient residual function of the diencephalon and brain stem, in order to maintain an autonomous and motor reflexes and sleep-wake cycles. Patients can have complex reflexes, incl. Eye movements, yawning and involuntary movements to painful stimuli, but they show no awareness of themselves or their environment. A minimally conscious state is characterized as opposed to a vegetative state, by signs of a self-awareness or perception of the environment, and patients have a tendency to improvement. The diagnosis is made clinically. Treatment is mainly supportive. The prognosis for patients with persistent deficits typically desolate. The vegetative Zutsand is a chronic phenomenon in which the ability to receive, maintain blood pressure, respiration and heart function, but not cognitive function. Hypothalamic functions and medullary brain stem functions remain intact to support cardiorespiratory and autonomic functions, and are sufficient for survival, provided the medical and nursing care is appropriate. The cortex is severely damaged (extinction of cognitive function), but the reticular Activate drying system (ARAS) remains functional (allows alertness). Midbrain or pontine reflexes may be present or absent. Patients have no self-awareness and interact with the environment only by reflexes. Seizure activity may be present but not clinically apparent. Traditionally considered a vegetative state lasting> 1 month, as a persistent vegetative state. However, the diagnosis of coma vigil does not imply a permanent disability because in very rare cases (eg. As after traumatic brain injury) improve patient and to reach a minimally conscious state or a higher level of consciousness. The most common causes are head injury Diffuse Cerebral hypoxia However, any disorder that leads to brain damage, causing a vegetative state. Usually a vegetative Zutsand however, does not occur because the function of the brain stem and midbrain is regained after a coma, cortical function. When minimally conscious state, there is, in contrast to the vegetative state, evidence that patients are aware of them themselves and / or their environment. The patients also show a tendency for improvement (i. E. They are gradually conscious), but has been limited progress. This condition can be the first signs of brain damage or follow a vegetative state when patients regain functions again. Patients can switch from the vegetative state in the minimally conscious state, which sometimes occurs years after the initial brain damage. Symptoms and complaints Vegetative state patients show no signs of awareness of themselves or their environment and can not interact with other people. Targeted responses to external stimuli as well as language comprehension and expression are lacking. Character of an intact reticular formation (z. B. eye opening), and an intact brain stem (z. B. reactive pupils, okulozephaler reflex) are present. Although sleep-wake cycles occur, but they do not necessarily reflect a certain circadian rhythm and not related to the environment in context. More complex brain stem reflexes, incl. Yawning, chewing, swallowing and, rarely, guttural sounds, are also provided. Arousal – and startle response can be obtained, for example. B. can cause loud noises or light flashes one eye open. The eyes are moist and produce tears. It may look as if the patient smile or scowl three. Spontaneous, roving eye movements-often are slow, misinterpreted at a constant speed and without saccade can be used as arbitrary sequence of movement and can be missvertsanden by the members as a sign of confidence. The patient can not respond to visual stimulation and not follow prompts. The limbs can move, but the eini Zigen purpose movements that occur are primitver type (eg. As grasping an object that touches the hand). Pain usually resolves a motor response from (typically Dekortikations- or Dezerebrationshaltung), but no specific defensive movement. Patients have a incontinency. Cranial nerve function and spinal reflexes are usually obtained. Rarely, shows the brain activity that is detected by functional MRI or EEG to a response to questions and requests, although there is no behavioral response. The extent of actual consciousness of Patientenist not yet known. In most patients who have such brain activity, the vegetative state caused by a traumatic head injury and not conscious of a hypoxic state Enzephalopathie.Minimal fragments of a meaningful interaction with the environment are preserved. Patients can make eye contact, targeted reach for objects, responding to prompts in a stereotypical manner or respond with the same word. Diagnosis Clinical criteria after sufficient observation neuroradiological imaging Characteristic findings (z. B. no purposeful activity or understanding), and characters of an intact reticular formation indicate a vegetative state. The diagnosis is made by clinical criteria. However, a neuroradiological imaging is displayed in order to exclude treatable disorders. The vegetative state must be distinguished from the minimally conscious state. Both conditions can be permanent or temporary, and the physical examination can not reliably distinguish both. A sufficient monitoring is necessary. With too short observation time signs of consciousness can be overlooked. Some patients with severe Parkinson’s disease can be misdiagnosed as a patient in a vegetative state. With CT or MRI ischemic infarction, intracerebral hemorrhage and a lesion by lesion involving cortex or brain stem can be distinguished. MR angiography can be used to represent the cerebral vasculature after exclusion of cerebral hemorrhage. Diffusion-weighted MRI is to pursue becoming the preferred way ongoing ischemic changes in the brain. PET and SPECT can be used to assess brain function (rather than the anatomy of the brain). If the diagnosis of persistent vegetative Zutsand doubtful a PET or SPECT should be performed. The EEG is useful in the assessment of cortical dysfunction, and the identification of concealed seizure activity. Vegetative state forecast prognosis varies somewhat depending on the cause and duration of the vegetative state. It is more favorable prognosis when a reversible metabolic disorder, the cause is (z. B. toxic encephalopathy) than when neuronal death by extended hypoxia and ischemia or other interference is based. Younger patients can more motor functions not recover than older, but more cognition, behavior or language. A recovery from a vegetative Zutsand is unlikely after one month at non-traumatic brain injury and after 12 months when a traumatic brain injury is based. Although entering some recovery after these periods, most patients are severely disabled. Rarely there is a late improvement; after 5 years gain approximately 3% of patients, or the ability to communicate and to understand back, but even less able to live independently; no patient achieved a normal function. If a vegetative state continues, most patients die within 6 months of the original brain injury. The cause is pneumonia usually a urinary tract infection or multiple organ failure or death can occur suddenly of unknown cause. With most of the remaining patients, life expectancy is about 2-5 years; only about 25% of patients survive> 5 years. Few patients survive jahrzehntelang.Minimal conscious state Most patients tend to regain consciousness, but to a limited extent, depending on the duration of the minimally conscious state. The longer this has lasted, the lower the chances of patients recovery higher cortical functions. The prognosis may be more favorable if the cause is a traumatic brain injury. Rarely get patients after years in a coma again a clear but limited awareness that describe the media as a revival. Treatment Supportive treatment of supportive therapy is the mainstay of therapy for patients in a vegetative state or minimally conscious state, and should include: prevention of systemic complications due to immobilization (such as pneumonia, urinary tract infection, thromboembolism.) Supply of good nutrition prevention of pressure ulcers providing physical therapy to contracture. For the vegetative state, there is no specific treatment. In deciding on any life-sustaining care, social services, the Ethics Committee of the hospital and family members should be included. The follow-up care of patients in a persistent vegetative state, especially from patients without present advance instruction to end medical treatment measures, raises ethical and other questions (eg. As the use of resources). Most patients in a minimally conscious state does not respond to certain treatments. Rarely, however, can cause a dramatic and repeated improvement of neurological responsiveness to treatment with zolpidem as long as the drug is administered on. Conclusion A vegetative state is characterized usually by absence of reaction and consciousness as a result of above-average dysfunction of the cerebral hemispheres, intact brain stem functions and sometimes by the illusion of consciousness, although this is not available from. The minimally conscious state differs from the vegetative state because the patient interact little with the environment and the passage of time have a tendency to improvement. Diagnosis requires the exclusion of other diseases and often long-lasting observation v. a. to the vegetative state, to distinguish the minimally conscious state and Parkinson’s disease. The prognosis is generally unfavorable, especially for patients in a vegetative state. Treatment is mainly supportive.

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