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)


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.

Access the Clinical Cases Database

A subscription is required to read the full article. Please subscribe using one of the options below.

Foundation Years Clinical Cases Database£29.006 months
Add to cart
Foundation Years Clinical Cases Database£39.0012 months
Add to cart


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


1. Levy DE, Knill-Jones RP, Plum F (1978) The vegetative state and its prognosis following nontraumatic coma. Ann N Y Acad Sci, 315:293–306.
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.


Conflict Of Interest

The Journal requires that authors disclose any potential conflict of interest that they may have. This is clearly stated in the Journal’s published “Guidelines for Authors”. The Journal follows the Guidelines against Conflict of Interest published in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (

Financial Statement

The authors of this article have not been paid. The Journal is financed by subscriptions and advertising. The Journal does not receive money from any other sources. The decision to accept or refuse this article for publication was free from financial considerations and was solely the responsibility of the Editorial Panel and Editor-in-Chief.

Patient Consent statement

All pictures and investigations shown in this article are shown with the patients’ consent. We require Authors to maintain patients’ anonymity and to obtain consent to report investigations and pictures involving human subjects when anonymity may be compromised. The Journal follows the Guidelines of the Uniform Requirements for Manuscripts ( The Journal requires in its Guidelines for Authors a statement from Authors that “the subject gave informed consent”.

Animal & Human Rights

When reporting experiments on human subjects, the Journal requires authors to indicate whether the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the HelsinkiDeclaration of 1975, as revised in 2008.

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.

The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.