BUL4602 Fall-2011 Lecture 10 , Reading 5

BUL4602 Fall-2011 Lecture 10 , Reading 5 - VM Diagnosing 1...

Info icon This preview shows pages 1–2. Sign up to view the full content.

View Full Document Right Arrow Icon
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, the
Image of page 1

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Image of page 2
This is the end of the preview. Sign up to access the rest of the document.

{[ snackBarMessage ]}

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern