Vegetative State: Everything You Need To Know

There are many disturbances that can affect the level of consciousness, and the vegetative state occupies a prominent place in this very broad topic. Previously, this term was used to refer to patients with loss of consciousness and whose vital functions were replaced.

It was not until the 1970s that two renowned neurologists, Brian Jennet and Freud Plum, decided to make the first scientific description of the disease. Since then,  several articles have been published analyzing the vegetative state from different angles,  and there are still controversies under discussion.

In this article, we’ll explain the most important things you need to know about the vegetative state.

What is the vegetative state?

To better explain this state, let’s divide the brain into two parts, according to what they control:

• The cerebral hemispheres control thinking 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 neurons that are in the cortex of the hemispheres.

• The diencephalon, composed of the thalamus and hypothalamus, and the brainstem control vital functions. This includes wake cycles, body temperature, breathing, blood pressure, heart rate, etc. That part of the brain would be like our primitive brain.

A vegetative state is a long-lasting disorder that occurs when the cerebral hemispheres stop functioning. Therefore, the person is no longer aware of himself and the environment. However, the most primitive brain, which continues to maintain its vital functions, is not affected.

Causes of the vegetative state

There are several causes of the vegetative state, as  any disorder that causes brain damage can lead to this state.

Normally, it occurs because, after the causative agent,  the function of the brainstem and diencephalon resumes, but the same does not occur with the function of the cerebral cortex or the cortical function.

The  most common causes  are:

• Head trauma: for example, a motorcycle rider without a helmet who had a motorcycle accident and hit 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 not to reach it and leading to a stroke.

Other causes can be tumors, hemorrhages, brain infections, late stages of dementia like Alzheimer’s, etc. These disorders do not harm the primitive brain, but they do damage the cerebral cortex.

Vegetative State Symptoms

People in a vegetative state can do some  things that make us think they might be aware, such as:

• Open your eyes. The patient can alternate sleep times with eyes closed, with periods when the eyes are kept open.
• They can breathe, suck, chew, cough, choke, swallow, make sounds, etc.
• They  can  even react to strong stimuli, such as noise, and sometimes appear 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 human beings have.

How can we know that patients are not conscious?

To determine whether someone is conscious, there must be intent in their actions. This intention tells us that something is related to the external environment:

• The patient can open and close the eyes and perform eye movements, but these are without purpose. Movements are random and independent of the stimuli in front of you. For example, if the patient has his eyes open and we place a pencil in front of him, he will not follow him with his eyes if we move him.
• It does not perform any voluntary or intentional motor movement. If he makes a gesture or lifts a limb, it is because he reacts to intense stimuli we give him. They can be, for example, wake-up reflexes and startle reflexes due to noise. The rest of the movements will be primitive reflexes, such as sucking, chewing, swallowing, etc.

• Can’t speak, doesn’t utter a word. If it makes any sound, it will be a kind of grunt or other primitive noise.
• If he receives a verbal or written order, he will not obey it, he will not react to it.
• Presents urinary and fecal incontinence.

Therefore, we see that  the patient is not aware of anything, but his heart and lungs are still functioning. That is, it can maintain your blood pressure and cardiorespiratory functions.

Diagnosis

Diagnosis is based on the physician’s assessment of symptoms. Although the patient presents the entire clinical picture of a vegetative state, it is necessary to observe him for a period of time to confirm this state. Otherwise, certain signs of conscience may be overlooked.

Imaging tests can be done to find out which part of the brain has been affected and whether it can be treated. To check if there is some kind of awareness, tests such as functional MRI or electroencephalogram are used to measure brain activity.

Unfortunately,  these tests cannot detect the amount of awareness that patients have, they  only detect if there is an awareness that cannot be determined with the naked eye. These results can affect decisions about long-term care and whether or not recovery is possible.

Prognosis of the vegetative state

Generally, after more than a month, the condition is considered a persistent vegetative state. However, it was observed that the cause of the vegetative state, its duration and the patient’s age are the factors that can alter the prognosis.

Some recovery may occur, although the condition has been considered permanent, but it will always be minimal, with large residual consequences and a low 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 they are supported. Also, blood stagnates in the veins, causing thrombi or blood clots. To avoid this, the patient must be passively moved.
• Good nutrition: through tubes that go from the mouth/nose to the esophagus or directly to the stomach. Nutrients can also be administered intravenously.
• Good cleaning of tubes and patient  to prevent infections.

The possibility of non-recovery

In these patients, recovery is unlikely. Doctors, family members and sometimes the hospital ethics committee should discuss how the patient will be treated. The patient’s wishes about these treatments should be considered if they are known or written down in a will.