Persistent vegetative state Flashcards
Define conciousness
State of full awareness of the self and ones relationship and environment
What is arousal
Sleep-wake cycle
What is content
Sum total of all interactions
What part of the brain is involved in arousal
Reticular activating system
Where does arousal begin
Rostral midbrain and mid pons
Where do the rostral midbrain and mid pons project to during arousal
Subthalamus
Hypothalamus
Thalamus
Basal forebrain
Are arousal and awareness high or low normally
Both high
Are arousal and awareness high or low in coma/ asleep/ under anaesthesia
Both low
In a vegetative state are arousal and awareness low or high
Arousal is high
Awareness is low
In a minimally concious state are arousal and awareness low or high
Arousal is high
Awareness is mid- low
Define vegetative state
Complex neurological condition in which patient appears to be awake but shows no awareness of themselves/ environement
Define minimal conciousness state
Wakefullness accompanised by inconsistent but reproducable signs of awareness
Give some features of a minimally concious state
Non-reflexic response to sensory stimulus
Awareness or self/ environement
Language comprehension
Lack of object use`
What are the parameters for vegetative state to be characterised as persistent
> 1 month
What are the parameters for a vegetative state to be characterised as permenant
> 12 months for traumatic
> 6 months for anoxic
Name 2 anatomical correlates seen in persistent vegetative state
White matter cell death
Disconnection from fronto-parietal cortex
List the states from least alert/ aware to most
Coma Persistent vegetative state Minimally concious state Confusional state Normal
Difference between coma and PVS
Eyes open
Difference between PVS and MCS
Fixates gaze
Follows command
Difference between MCS and confusional state
Object use
Criteria for PVS (3)
Cycles of eye opening and closing
Complete lack of awareness of self/ environment
Complete/ partial preservation of hypothalamus and brainstem autonomic function
What is cerebral metabolism highest/ lowest in
Highest in normal conciousness
Lowest in vegetative state
Are somatosensory evoked potentials absent, higher, or lower in PVS
Absent
Is REM seen in minimally concious state
Yes
Name 3 factors that affect recovery time of persistent vegetative state
- Time
- Age
- Type of injury
What % of people aged <20 maintain independence after PVS
21
What % of people from 20-39 maintain independence after PVS
9
What % of >39 maintain independence after PVS
0
Are outcomes better if PVS was caused by trauma or anoxic
Trauma
What % of people maintain independence after PVS is cause was
a) traumatic
b) anoxic
a) 24
b) 4
What % of people maintain conciousness after PVS if cause was
a) traumatic
b) anoxic
a) 52
b) 13
Name 2 pharmacological treatments for PVS
Amantadine
Zolpidem
