A vegetative state is when someone is awake but not aware due to brain damage from trauma, infection, or neurotoxins. Diagnosis is complicated and misdiagnosis can be life-threatening. Patients in this state have basic reflexes but cannot communicate or intentionally interact with their surroundings. Recovery is possible but chances decrease over time. Advocates are important to ensure accurate diagnosis and avoid misdiagnosis.
A vegetative state is a condition in which someone is awake, but not aware. People usually emerge from a coma in a state where their brain slowly recovers from the injury and they begin to become more alert and aware. From this state, a patient can transition to a minimally conscious state and then to a fully conscious state. However, sometimes patients do not recover from this state because their brain is too badly damaged.
Many different events can cause brain damage resulting in a coma, including trauma, infection, and exposure to neurotoxins. When a patient is in a vegetative state, no higher brain function is observed, but the patient’s brainstem is intact. This means that the patient has some basic reflexes and can usually breathe independently, but cannot communicate, understand spoken language, or intentionally interact with their surroundings.
Diagnosing a vegetative state is complicated and misdiagnoses occur. This is extremely problematic because misdiagnosing a patient can literally mean the difference between life and death. One study showed people in a supposed vegetative state who were capable of learning, for example, which meant their higher brain functions were not only intact, but functioning. A variety of tests can be done to examine patients who have suffered brain injuries to determine their level of consciousness, but the test results are not always entirely reliable; patients in the 2009 study discussed above were diagnosed and confirmed as being in a vegetative state, for example, despite the fact that they weren’t.
When a patient remains in this condition for more than a month, the term “persistent vegetative state” may be used to describe the patient. It is possible to recover after more than a month, but the chances become increasingly slim as time goes by. After a year or more, the patient is said to be in a permanent vegetative state. However, this is also a bit of a misnomer, as there have been reports of patients recovering from supposedly permanent states.
Patients in this state have sleep-wake cycles, can open their eyes, laugh, cry or smile, and react to unpleasant stimuli. However, they are unaware of their surroundings. They also require nursing support because while they can breathe on their own, they cannot feed themselves and have difficulty with most daily activities.
When someone suffers a brain injury that results in a presumed coma, vegetative state, or minimally conscious state, it’s important that the patient has advocates. It is imperative to be very thorough when diagnosing to confirm it is correct and to avoid a situation such as misdiagnosing someone with Lockdown Syndrome, where the patient is wide awake and aware, but unable to move. It’s also important to note that neither of these conditions is equivalent to brain death.
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