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Unformatted text preview: V.swashirtual M.swashentor. August 2004 , Volume 6, Number 8. Clinical Pearl Diagnosing The Permanent Vegetative State Ronald Cranford, MD Modern medicine and newer life-saving treatments have not only resulted in the saving of an untold number of lives and preservation and restoration of health but, as an unfortunate and unavoidable by-product, they have created syndromes of severe brain damage rarely seen, if at all, prior to these advances in medical therapy. These syndromes include brain death, the minimally conscious state, locked-in syndrome, and, probably the most widely known example, the permanent vegetative state. In the middle of the last century, most physicians would have thought it strange to envision a neurological syndrome wherein the patient manifests sleep-wake cycles with periods of eyes open and yet possesses no consciousness whatsoever during those wakeful periods. This state—the permanent vegetative state—is a condition of wakeful unawareness, a form of permanent unconsciousness. Originally described and named by Fred Plum and Brian Jennet in 1972, this neurological syndrome is now well known to most doctors who treat neurological disorders. Furthermore, many of the landmark right-to-die legal cases in the United States have involved patients in a permanent vegetative state, beginning with Karen Quinlan, the first major termination-of-treatment case in the US to reach the state supreme court level (in New Jersey, 1975); Nancy Cruzan, the first right-to-die case to reach the United States Supreme Court (1990), and, more recently, the widely publicized case of Terri Schiavo, now pending before the Florida Supreme Court. Although cases of the permanent vegetative state were undoubtedly rare prior to the 1960s, the Multi-society Task Force on the Persistent Vegetative State estimated in 1994 that there were 10,000 to 25,000 adults and 4,000 to 10,000 children in persistent vegetative states in the United States. The reason why these patients experience periods of wakeful unawareness is readily explainable by the underlying characteristic neuropathological changes present in most patients. Whatever the primary cause of the vegetative state, such as hypoxic-ischemic encephalopathy secondary to a cardiac or pulmonary arrest, or shearing injuries in brain trauma, there is extensive damage to the higher centers of the brain, with relative preservation of the brain stem structures. Hence, thehigher centers of the brain, with relative preservation of the brain stem structures....
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This note was uploaded on 08/23/2011 for the course BUL 4602 taught by Professor Johnson during the Spring '11 term at W. Florida.
- Spring '11