Clinical Case Database / Category: Clinical Care

Persistent vegetative state

Publication details

Laura Creasy BA (Hons), BMBCh, Memoona Khan MBBS, Nicholas Brennan BSc (Hons), MBChB,, Chitrabhanu Ballav MBBS, MRCP(UK), Ian Gallen MD, FRCP, MB, BS
Foundation Years Journal, volume 4, issue 3, p.26 (123Doc Education, London, March 2010)

Abstract

A 21-year-old man was brought in to the A&E department by ambulance following an out of hospital cardiac arrest. He had overdosed on alcohol and methadone. He was successfully resuscitated in A&E. His cardiovascular and respiratory examination was normal. He was unresponsive to pain and generally hypertonic. He was initially intubated and then went on to have a tracheotomy. He recovered normal breathing and was weaned off the ventilator. However, he remained unresponsive to voice or pain. A CT head showed a tight brain, consistent with hypoxic damage. There was no evidence of space occupying lesion, haemorrhagic or ischaemic cerebrovascular attack. Over the next few days he became awake, with his eyes open and closed resembling sleep–wake cycles. He still did not respond to visual, auditory, tactile stimuli or pain. He made occasional non-purposeful grimaces and sounds. During the course of his admission, a percutaneous endoscopic gastrostomy (PEG) tube was inserted to provide nutrition. He received regular physiotherapy and his posture was passively changed frequently to offload pressure points. He had occasional infections of chest and urine, which were treated with antibiotics. He was diagnosed with persistent vegetative state and after about 6 months of hospital care he was transferred to a care home specialising in caring for such patients.

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Authors

Laura Creasy BA (Hons), BMBCh

Foundation Year 2
Buckinghamshire Hospital
NHS Trust Wycombe Hospital
Queen Alexandra Road
High Wycombe, Bucks
HP11 2TT

Memoona Khan MBBS

Foundation Year 2
Buckinghamshire NHS Trust

Nicholas Brennan BSc (Hons), MBChB,

Foundation Year 1
Buckinghamshire NHS Trust

Chitrabhanu Ballav MBBS, MRCP(UK)

Specialty Trainee Year 4
Buckinghamshire NHS Trust

Ian Gallen MD, FRCP, MB, BS

Consultant Diabetologist and Physician
Buckinghamshire NHS Trust

References

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2. The vegetative state: guidance on diagnosis and management. RCP guidelines 2003.
3. Beaumont GJ, Kenealy PM (2005) Incidence and prevalence of the vegetative and minimally conscious states. Neuropsychological Rehabilitation, 15:3.
4. Laureys S, et al. (2004) Brain function in coma, vegetative state and related disorders. The Lancet Neurology, 3(9):537–546.
5. Gillies JD, Seshia SS (1980) Vegetative state following coma in childhood: evolution and outcome. Dev Med Child Neurol, 22:642–648.
6. Bricolo A, Turazzi S, Feriotti G (1980) Prolonged post-traumatic unconsciousness: therapeutic assets and liabilities. J Neurosurg, 52:625–634.
7. Jennett B, Plum F (1972) Persistent vegetative state after brain damage. Lancet, i:734–737.
8. International working party report on the vegetative state (1996) London: Royal Hospital for Neuro-disability.
9. BMA Ethics (2009) End of life issues – views of the BMA, August.

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About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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