Persistent Vegetative State

Question 1

Which system is involved in maintaining arousal?

Answer 1

Reticular activating system

Question 2

Which structures are in the reticular activating system, responsible for arousal?

Answer 2

Rostral midbrain and mid pons

Question 3

Define ‘vegetative state’

Answer 3

Patient appears to be awake but shows no signs of awareness of themselves or the environment

Question 4

Define ‘minimal consciousness sate’

Answer 4

Wakefulness accompanied by inconsistent but reproducible signs of awareness (language expression/comprehension, visual tracking etc)

Question 5

What is akinetic mutism?

Answer 5

Patient is awake but have a diminished drive to respond

Question 6

Define ‘persistent vegetative state’

Answer 6

If they are unaware for >1 month

Question 7

Define ‘permanent vegetative state’

Answer 7

If they are unaware for >6 months (or>12 months for traumatic injury)

Question 8

What structures are thought to be involved in producing a vegetative state?

Answer 8

Damage to the thalamus, fronto-parietal cortex and subcortical white matter

Question 9

How may drugs be used to treat a vegetative state?

Answer 9

Evidence that amantadine and zolpidem may improve prognosis after brain injury

Question 10

How may a vegetative state be treated with deep brain stimulation?

Answer 10

To the central thalamic nuclei