Persistent vegetative state

Question 1

Define conciousness

Answer 1

State of full awareness of the self and ones relationship and environment

Question 2

What is arousal

Answer 2

Sleep-wake cycle

Question 3

What is content

Answer 3

Sum total of all interactions

Question 4

What part of the brain is involved in arousal

Answer 4

Reticular activating system

Question 5

Where does arousal begin

Answer 5

Rostral midbrain and mid pons

Question 6

Where do the rostral midbrain and mid pons project to during arousal

Answer 6

Subthalamus
Hypothalamus
Thalamus
Basal forebrain

Question 7

Are arousal and awareness high or low normally

Answer 7

Both high

Question 8

Are arousal and awareness high or low in coma/ asleep/ under anaesthesia

Answer 8

Both low

Question 9

In a vegetative state are arousal and awareness low or high

Answer 9

Arousal is high

Awareness is low

Question 10

In a minimally concious state are arousal and awareness low or high

Answer 10

Arousal is high

Awareness is mid- low

Question 11

Define vegetative state

Answer 11

Complex neurological condition in which patient appears to be awake but shows no awareness of themselves/ environement

Question 12

Define minimal conciousness state

Answer 12

Wakefullness accompanised by inconsistent but reproducable signs of awareness

Question 13

Give some features of a minimally concious state

Answer 13

Non-reflexic response to sensory stimulus
Awareness or self/ environement
Language comprehension
Lack of object use`

Question 14

What are the parameters for vegetative state to be characterised as persistent

Answer 14

> 1 month

Question 15

What are the parameters for a vegetative state to be characterised as permenant

Answer 15

> 12 months for traumatic

> 6 months for anoxic

Question 16

Name 2 anatomical correlates seen in persistent vegetative state

Answer 16

White matter cell death

Disconnection from fronto-parietal cortex

Question 17

List the states from least alert/ aware to most

Answer 17

Coma
Persistent vegetative state
Minimally concious state
Confusional state
Normal

Question 18

Difference between coma and PVS

Answer 18

Eyes open

Question 19

Difference between PVS and MCS

Answer 19

Fixates gaze

Follows command

Question 20

Difference between MCS and confusional state

Answer 20

Object use

Question 21

Criteria for PVS (3)

Answer 21

Cycles of eye opening and closing
Complete lack of awareness of self/ environment
Complete/ partial preservation of hypothalamus and brainstem autonomic function

Question 22

What is cerebral metabolism highest/ lowest in

Answer 22

Highest in normal conciousness

Lowest in vegetative state

Question 23

Are somatosensory evoked potentials absent, higher, or lower in PVS

Answer 23

Absent

Question 24

Is REM seen in minimally concious state

Answer 24

Yes

Question 25

Name 3 factors that affect recovery time of persistent vegetative state

Answer 25

• Time
• Age
• Type of injury

Question 26

What % of people aged <20 maintain independence after PVS

Answer 26

21

Question 27

What % of people from 20-39 maintain independence after PVS

Answer 27

9

Question 28

What % of >39 maintain independence after PVS

Answer 28

0

Question 29

Are outcomes better if PVS was caused by trauma or anoxic

Answer 29

Trauma

Question 30

What % of people maintain independence after PVS is cause was

a) traumatic
b) anoxic

Answer 30

a) 24

b) 4

Question 31

What % of people maintain conciousness after PVS if cause was

a) traumatic
b) anoxic

Answer 31

a) 52

b) 13

Question 32

Name 2 pharmacological treatments for PVS

Answer 32

Amantadine

Zolpidem