The vegetative state is a disorder that occurs when only our primitive brain remains active and we stop being aware of ourselves and the environment. Discover in this article what it is, what symptoms it presents, the diagnosis and its prognosis.
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There are many alterations that can affect the level of consciousness and the vegetative state occupies a prominent place in this broad topic. Formerly, it was described as an entity to refer to patients with unconsciousness and whose vital functions were generally substituted.
It wasn’t until the 1970s that two renowned neurologists, Brian Jennet and Freud Plum , decided to make the first scientific description of the disease. Since then, multiple articles have been published analyzing the vegetative state from different angles and there are still controversies that are under discussion.
In this article we will explain the most important aspects that you have to know about the vegetative state.
What is the vegetative state?
In order to better explain this entity, we are going to divide the brain into two parts , depending on what they control:
- The cerebral hemispheres control thought and behavior,making us aware of ourselves and our environment. In them we find the different lobes – frontal, temporal, occipital, parietal – with their respective functions, performed by the neurons that are in the cortex of the hemispheres.
- The diencephalon, made up of the thalamus and hypothalamus, and the brain stem control vital functions. These include sleep-wake cycles, body temperature, respiration, blood pressure, heart rate, etc. This part of the brain would be like our primitive brain.
Continue reading: Parts of the brain and their functions
A vegetative state is a long-lasting disorder that occurs when the cerebral hemispheres stop working. Therefore, the person ceases to be aware of himself and the environment. However, the most primitive brain, which continues to have its vital functions, is not affected.
“They are not unconscious or comatose in the usual sense of the word, they are awake without consciousness”
– Jennet and Plum –
Vegetative state causes
There are several causes of the vegetative state, since any disorder that leads to brain damage can cause this state .
Normally, it occurs because, after the causative agent, the function of the brainstem and diencephalon resume , but the same does not happen with the function of the cerebral cortex or cortical function.
The most frequent causes are:
- Head trauma:for example, a helmetless motorcyclist who has a motorcycle accident and hits his head.
- A disorder that deprives the brain of oxygen, such as cardiac arrest or respiratory arrest
- Cerebrovascular disease: for example, an artery in the brain is occluded causing blood to not reach and leading to a stroke.
Other causes can be tumors, hemorrhages, brain infections, final stages of dementias like Alzheimer’s, etc. These disorders do not harm the primitive brain, but do damage the cerebral cortex.
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Symptoms of the vegetative state
People in a vegetative state can do some things that would make us think they may be aware , such as:
- Open your eyes. The patient can alternate sleep times with the eyes closed, with periods in which the eyes are kept open.
- They can breathe, suck, chew, cough, gag, swallow, make sounds, etc.
- They caneven react to strong stimuli like big noises and sometimes seem to smile or frown.
However, these reactions are carried out by the primitive brain without any awareness. They are the result of basic involuntary reflexes that all humans have.
How can we know that they are not conscious?
To determine if someone is conscious, there must be intention in their actions . This intention indicates that it is relating to the external environment:
- The patient can open and close the eyes and perform eye movements, but these have no purpose. The movements are random and independent of the stimuli in front of them. For example, if you have your eyes open and we put a pencil in front of you, it will not follow you with your eyes if we move it.
- It does not make any voluntary or intentional motor movement. If he makes a gesture or raises a limb, it is because he reacts to intense stimuli that we give him. They can be, for example, reflexes of awakening and startle by loud noises. The rest of the movements will be primitive reflexes, such as sucking, chewing, swallowing, etc.
- He cannot speak, he does not utter a word. If it makes any noise, it will be growling or primitive noise.
- If you are given a verbal or written order, you will not follow it , you will not react to it.
- You have urinary and fecal incontinence .
Therefore, we see that the patient is not aware of anything, but his heart and lungs continue to function . That is, it can maintain your blood pressure and cardiorespiratory functions.
The diagnosis is based on the evaluation of the symptoms by the doctor. Although the patient presents the entire clinic from a vegetative state, it is necessary to observe the patient for a period of time in order to confirm this state . If not, certain signs of consciousness may be overlooked.
Imaging tests can be done to locate what part of the brain has been affected and see if it can be treated. In order to see if there is any kind of consciousness, tests such as functional magnetic resonance imaging or electroencephalogram are used to measure brain activity.
Unfortunately, these tests cannot detect the amount of consciousness that patients have, they only detect if there is consciousness that cannot be determined with the naked eye. These results may affect decisions about long-term care and the possibility or not of recovery.
Vegetative state forecast
Generally, after more than a month , it is considered to be a persistent vegetative state. However, it has been seen that the cause of the vegetative state, its duration and the age of the patient are the factors that can change the prognosis.
Some recovery may appear , although it has already been considered permanent, but this will always be minimal, with large residual consequences and a poor quality of life.
Vegetative state treatment
People in a vegetative state need comprehensive care . Above all, we must provide the following measures:
- Preventive measures for problems due to immobilization: ulcers or contractures can occur in the areas where it is supported. In addition, blood stagnates in the veins causing thrombi or blood clots. To avoid this, the patient must be mobilized passively.
- Good nutrition:through tubes that go from the mouth / nose to the stomach or directly to the stomach. Nutrients can also be administered intravenously.
- Good cleaning of the tubes and the patientto avoid infections.
The possibility of non-recovery
Recovery is unlikely in these patients. Doctors, family, and sometimes the hospital ethics committee must discuss how the patient will be treated. The patient’s wishes about these treatments should be considered if they are known or written in the living will.