Unexpected emergence from the vegetative state: delayed discovery rather than late recovery of consciousness.

Abstract:

BACKGROUND:The vegetative state, also known as the unresponsive wakefulness syndrome, is one of the worst possible outcomes of acquired brain injury and confronts rehabilitation specialists with various challenges. Emergence to (minimal) consciousness is classically considered unlikely beyond 3-6 months after non-traumatic or 12 months after traumatic etiologies. A growing body of evidence suggests that these timeframes are too narrow, but evidence regarding chances of recovery is still limited. OBJECTIVE:To identify the moment of recovery of consciousness in documented cases of late emergence from a vegetative state. METHODS:Four cases of apparent late recovery of consciousness, identified within a prospective cohort study, were studied in-depth by analyzing medical, paramedical and nursing files and interviewing the patients' families about their account of the process of recovery. RESULTS:All patients were found to have shown signs of consciousness well within the expected time frame (5 weeks-2 months post-ictus). These behaviors, however, went unnoticed or were misinterpreted, leading to a diagnostic delay of several months to over 5 years. Absence of appropriate diagnostics, the use of erroneous terminology, sedative medication but also patient-related factors such as hydrocephalus, language barriers and performance fluctuations are hypothesized to have contributed to the delay. CONCLUSIONS:Delayed recognition of signs of consciousness in patients in a vegetative state may not only lead to suboptimal clinical care, but also to distorted prognostic figures. Discriminating late recovery from the delayed discovery of consciousness, therefore, is vital to both clinical practice and science.

journal_name

J Neurol

journal_title

Journal of neurology

authors

van Erp WS,Aben AML,Lavrijsen JCM,Vos PE,Laureys S,Koopmans RTCM

doi

10.1007/s00415-019-09542-3

subject

Has Abstract

pub_date

2019-12-01 00:00:00

pages

3144-3149

issue

12

eissn

0340-5354

issn

1432-1459

pii

10.1007/s00415-019-09542-3

journal_volume

266

pub_type

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