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Open Access 01-12-2019 | Hydrocephalus | Original Communication

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

Published in: Journal of Neurology | Issue 12/2019

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.

Available only for authorised users

Anonymized data will be shared by request from any qualified investigator.

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Title: Unexpected emergence from the vegetative state: delayed discovery rather than late recovery of consciousness
Publication date: 01-12-2019
Keywords: Hydrocephalus
Hydrocephalus
Hydrocephalus
Published in: Journal of Neurology / Issue 12/2019
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-019-09542-3

At a glance: The STEP trials

Springer Medicine

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

Abstract

Background

Objective

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Objective

Methods

Results

Conclusions

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