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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:
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SELF-AWARE-NESS |
SLEEP-WAKE CYCLES |
MOTOR FUNCTION |
EXPERI-ENCE OF SUFFERING |
RESPIRA-TORY |
EEG ACTIVITY |
CEREBRAL META- BOLISM |
PROGNOSIS
FOR |
|
PERSISTENT VEGETATIVE |
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: 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 |
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LOCKED- |
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) |
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SELF-AWARE-NESS |
SLEEP-WAKE CYCLES |
MOTOR FUNCTION |
EXPERI-ENCE OF SUFFERING |
RESPIRA-TORY |
EEG ACTIVITY |
CEREBRAL META- BOLISM |
PROGNOSIS
FOR |
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.
This Webpage was created for a workshop held at Saint Andrew's Abbey, Valyermo, California in 1990
