Permanent vegetative state (PVS) means an irreversible state of
wakefulness without awareness, associated with sleep-wake
cycles and preserved brainstem functions. There are no reliable
28 | Critical Care in Neurology
set of criteria defining and ensuring diagnosis of PVS in infants
under 3 months old, apart from anencephalics.
There are three major categories of disease in adults and
children that result in PVS, upon which the outcome of PVS
depends:
A. In acute traumatic and nontraumatic brain injury, PVS
usually evolves within 1 month of injury from a state of eyesclosed
coma to a state of wakefulness without awareness with
sleep-wake cycles and preserved brainstem functions.
B. Some degenerative and metabolic disorders of the brain (i.e.,
late stage of dementia of Alzheimer type, end stage of Parkinson
disease, and motor neuron disease, pontine myelinolysis, severe
uncorrected hypoglycaemic coma) inevitably progress toward an
irreversible vegetative state. Patients who are severely impaired
but retain some degree of awareness may lapse briefly into a
vegetative state from the effects of medication, infection,
superimposed illnesses, or decreased fluid and nutritional
intake. Such a temporary encephalopathy must be corrected
before labeling that patient with the diagnosis of PVS.
Consciousness recovery is unlikely if the vegetative state persists
for several months.
C. The third cause is severe developmental malformations of
the nervous system - the developmental vegetative state is a
form of PVS that affects some infants and children with severe
congenital malformations of the nervous system. These children
do not acquire awareness of self or their environment. This
diagnosis can be made at birth only in infants with anencephaly.
For children with other severe malformations who appear
vegetative at birth, observation for 3 to 6 months is
recommended to determine whether these infants acquire
awareness. The majority of such infants who are vegetative at
birth remain vegetative; those who acquire awareness usually
recover only to a severe disability.
wakefulness without awareness, associated with sleep-wake
cycles and preserved brainstem functions. There are no reliable
28 | Critical Care in Neurology
set of criteria defining and ensuring diagnosis of PVS in infants
under 3 months old, apart from anencephalics.
There are three major categories of disease in adults and
children that result in PVS, upon which the outcome of PVS
depends:
A. In acute traumatic and nontraumatic brain injury, PVS
usually evolves within 1 month of injury from a state of eyesclosed
coma to a state of wakefulness without awareness with
sleep-wake cycles and preserved brainstem functions.
B. Some degenerative and metabolic disorders of the brain (i.e.,
late stage of dementia of Alzheimer type, end stage of Parkinson
disease, and motor neuron disease, pontine myelinolysis, severe
uncorrected hypoglycaemic coma) inevitably progress toward an
irreversible vegetative state. Patients who are severely impaired
but retain some degree of awareness may lapse briefly into a
vegetative state from the effects of medication, infection,
superimposed illnesses, or decreased fluid and nutritional
intake. Such a temporary encephalopathy must be corrected
before labeling that patient with the diagnosis of PVS.
Consciousness recovery is unlikely if the vegetative state persists
for several months.
C. The third cause is severe developmental malformations of
the nervous system - the developmental vegetative state is a
form of PVS that affects some infants and children with severe
congenital malformations of the nervous system. These children
do not acquire awareness of self or their environment. This
diagnosis can be made at birth only in infants with anencephaly.
For children with other severe malformations who appear
vegetative at birth, observation for 3 to 6 months is
recommended to determine whether these infants acquire
awareness. The majority of such infants who are vegetative at
birth remain vegetative; those who acquire awareness usually
recover only to a severe disability.
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