COMA;
VEGETATIVE
STATE;
DEMENTIA;
DISABILITY.
 

 


BRAIN DEATH: [1] permanent cessation of all higher brain function;
[2] presumption of imminent asystole [the heart will inevitably stop beating within a short period of time]

COMA: continuously unconscious and unarousable; no alternation of periods of wakefulness and sleep.

PERSISTENT VEGETATIVE STATE: no evidence of self-awareness or conscious reaction to stimuli; alternate periods of sleep and wakefulness.

(1) no evidence of awareness of self or environment and an inability to interact with others;

(2) no evidence of sustained, reproducible, purposeful, or voluntary behavioral responses to visual, auditory, tactile, or noxious stimuli;

(3) no evidence of language comprehension or expression;

(4) intermittent wakefulness manifested by the presence of sleep-wake cycles;

(5) sufficiently preserved hypothalamic and brain-stem autonomic functions to permit survival with medical and nursing care;

(6) bowel and bladder incontinence; and

(7) variably preserved cranial-nerve reflexes (pupillary, oculocephalic, corneal, vestibulo-ocular, and gag) and spinal reflexes.

MINIMALLY CONSCIOUS STATE (?!)

DEMENTIA



COMPARISON CHART:

 
CONDITION

SELF-AWARE-NESS

SLEEP-WAKE CYCLES

MOTOR FUNCTION

EXPERI-ENCE OF SUFFERING

RESPIRA-TORY
FUNCTION

EEG ACTIVITY

CEREBRAL META- BOLISM

PROGNOSIS FOR
N
EUROLOGIC RECOVERY

 PERSISTENT VEGETATIVE
 
STATE

Absent

Intact

No purposeful movement

No

Normal

Polymorphic delta or theta, some times slow alpha

Reduced by 50% or more

Depends on cause (acute traumatic or nontraumatic injury, degenerative or metabolic condition, or developmental malformation)

  COMA

Absent

Absent

No purposeful movement

No

Depressed, variable

Polymorphic  delta or theta

Reduced by 50 or more (depends on cause

Usually:
recovery,

persistent vegetative state,

or death

in 2 to 4 weeks

  BRAIN   DEATH

Absent

Absent

None or only reflex spinal movements

No

Absent

Electro-cercbral silence

Absent

No recovery

 LOCKED-
IN SYN-DROME

Present

Intact

Quadriplegia and pseudobulbar palsy; eye movement preserved

Yes

Normal

Normal or minimally abnormal

Minimally or moderately

Recovery unlikely; persistent quadriplegia with prolonged survival possible

 DEMENTIA

Present but lost in late stages

Intact

Variable limited progression

Yes, but lost in late stages

Normal

Nonspecific slowing

Variably reduced

Irreversible (ultimate outcome depends on cause)

 
CONDITION

SELF-AWARE-NESS

SLEEP-WAKE CYCLES

MOTOR FUNCTION

EXPERI-ENCE OF SUFFERING

RESPIRA-TORY
FUNCTION

EEG ACTIVITY

CEREBRAL META- BOLISM

PROGNOSIS FOR
N
EUROLOGIC RECOVERY

Medical Aspects of the Persistent Vegetative State: First of Two Parts, The Multi-Society Task Force on PVS.  NEJM Volume 330:1499-1508 May 26, 1994, Number 21.

 

 


xcxxcxxc  F ” “ This Webpage was created for a workshop held at Saint Andrew's Abbey, Valyermo, California in 1990....x....   “”.