Neuropsychiatry of consciousness

2020 ◽  
pp. 161-168
Author(s):  
David Linden
Keyword(s):  
Vegetative State ◽  
Persistent Vegetative State ◽  
Mental States ◽  
Unresponsive Wakefulness Syndrome ◽  
Clinical Syndromes ◽  
Clinical Presentations ◽  
Clinical Scenarios ◽  
Ascending Reticular Activating System ◽  
Reticular Activating System ◽  
Neurophysiological Mechanisms

Consciousness requires wakefulness and awareness. Many neuropsychiatric syndromes involve the disturbance of these functions. This chapter provides an overview of the various clinical presentations involving quantitative or qualitative disturbances of consciousness in order to explore the associated pathologies and underlying neurophysiological mechanisms. It lays out a number of clinical syndromes associated with impaired consciousness, such as persistent vegetative state (PVS) or unresponsive wakefulness syndrome (UWS), where the patient’s bodily functions can continue independently and show activity in higher motor areas when prompted under functional magnetic resonance imaging, yet are unable to communicate or follow commands. Focus is then given to altered mental states where conditions, such as neuroleptic malignant syndrome (NMS), may cause patients to experience depersonalization, fugue states, and hallucinations. After exploring the neuroanatomy and neurophysiology of such disorders, with a description of the function and significance of the ascending reticular activating system (ARAS), a number of clinical scenarios are presented.

scholarly journals Brainstem dysfunction in critically ill patients

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Sarah Benghanem ◽  
Aurélien Mazeraud ◽  
Eric Azabou ◽  
Vibol Chhor ◽  
Cassia Righy Shinotsuka ◽  
...  
Keyword(s):  
Auditory Evoked Potentials ◽  
Cranial Nerves ◽  
Diagnostic Techniques ◽  
Motor Deficits ◽  
Vital Functions ◽  
Clinical Syndromes ◽  
Cranial Nerve Palsies ◽  
Ascending Reticular Activating System ◽  
Brainstem Dysfunction ◽  
Reticular Activating System

AbstractThe brainstem conveys sensory and motor inputs between the spinal cord and the brain, and contains nuclei of the cranial nerves. It controls the sleep-wake cycle and vital functions via the ascending reticular activating system and the autonomic nuclei, respectively. Brainstem dysfunction may lead to sensory and motor deficits, cranial nerve palsies, impairment of consciousness, dysautonomia, and respiratory failure. The brainstem is prone to various primary and secondary insults, resulting in acute or chronic dysfunction. Of particular importance for characterizing brainstem dysfunction and identifying the underlying etiology are a detailed clinical examination, MRI, neurophysiologic tests such as brainstem auditory evoked potentials, and an analysis of the cerebrospinal fluid. Detection of brainstem dysfunction is challenging but of utmost importance in comatose and deeply sedated patients both to guide therapy and to support outcome prediction. In the present review, we summarize the neuroanatomy, clinical syndromes, and diagnostic techniques of critical illness-associated brainstem dysfunction for the critical care setting.

Persistent vegetative state in head injury

2005 ◽  
Vol 2 (2) ◽  
pp. 81-85
Author(s):  
Deepak Kumar Gupta ◽  
AK Mahapatra
Keyword(s):  
Head Injury ◽  
Vegetative State ◽  
Persistent Vegetative State

scholarly journals Persistent vegetative state: an overview

2021 ◽  
Vol 36 (1) ◽  
Author(s):  
Gabriel Alexander Quiñones-Ossa ◽  
Yeider A. Durango-Espinosa ◽  
Tariq Janjua ◽  
Luis Rafael Moscote-Salazar ◽  
Amit Agrawal
Keyword(s):  
Intensive Care ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Clinical History ◽  
Main Body ◽  
Disorder Of Consciousness ◽  
Family Perspective ◽  
Patient Status ◽  
History Of ◽  
State Diagnosis

Abstract Background Disorder of consciousness diagnosis, especially when is classified as persistent vegetative state (without misestimating the other diagnosis classifications), in the intensive care is an important diagnosis to evaluate and treat. Persistent vegetative state diagnosis is a challenge in the daily clinical practice because the diagnosis is made mainly based upon the clinical history and the patient behavior observation. There are some specific criteria for this diagnosis, and this could be very tricky when the physician is not well trained. Main body We made a literature review regarding the persistent vegetative state diagnosis, clinical features, management, prognosis, and daily medical practice challenges while considering the bioethical issues and the family perspective about the patient status. The objective of this overview is to provide updated information regarding this clinical state’s features while considering the current medical literature available. Conclusions Regardless of the currently available guidelines and literature, there is still a lot of what we do not know about the persistent vegetative state. There is a lack of evidence regarding the optimal diagnosis and even more, about how to expect a natural history of this disorder of consciousness. It is important to recall that the patients (despite of their altered mental state diagnosis) should always be treated to avoid some of the intensive care unit long-stance complications.

Prognosis of patients in prolonged coma after severe carbon monoxide poisoning

2021 ◽  
pp. 096032712199799
Author(s):  
Y Gao ◽  
H Gu ◽  
J Yang ◽  
L Yang ◽  
Z Li ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
Poor Prognosis ◽  
Vegetative State ◽  
Carbon Monoxide Poisoning ◽  
Demographic Data ◽  
Laboratory Data ◽  
Persistent Vegetative State ◽  
Chronic Phase ◽  
Imaging Features ◽  
Prolonged Coma

Background: Late recovery in patients following prolonged coma from carbon monoxide poisoning have been reported, but the probability is unclear. The purpose of this research was to assess the prognosis of patients in prolonged coma after severe carbon monoxide poisoning and related clinical and imaging features. Methods: There were 13 patients who had been in a state of coma for >7 days after acute carbon monoxide poisoning in the retrospective observational study, and demographic data, clinical data, laboratory data, complications, and image data were collected. Outcome was assessed by means of the Glasgow outcome scale after 1 year. The relationship between complications and imaging manifestations and prognosis was also analyzed. Results: One year after severe carbon monoxide poisoning, two patients (15.4%) had died (GOS 1), nine (69.2%) were in a persistent vegetative state (GOS 2), one (7.7%) was moderately disabled (GOS 4), and one (7.7%) achieved a good recovery (GOS 5) with minimal disability. Conclusions: Most patients with prolonged coma after severe carbon monoxide poisoning had a poor prognosis, although the younger patients had a better prognosis. Respiratory failure, hypotension and renal failure during the course of the disease were associated with a poor prognosis. The prognosis of patients with injuries in two sites in early CT was poor. Multiple lesions (≥3) and extensive white matter damage (Fazekas grade (PVH or DWMH) = 3) on MRI of chronic phase were also associated with a poor prognosis.

Moral Justice and Legal Justice in Managed Care: The Ascent of Contributive Justice

1995 ◽  
Vol 23 (3) ◽  
pp. 247-265 ◽  
Author(s):  
E. Haavi Morreim
Keyword(s):  
Access To Health Care ◽  
Life Support ◽  
Vegetative State ◽  
Health Maintenance Organization ◽  
Persistent Vegetative State ◽  
Autologous Bone Marrow ◽  
Marrow Transplant ◽  
Health Maintenance ◽  
Access To Health ◽  
Aggressive Care

Several prominent cases have recently highlighted tension between the interests of individuals and those of the broader population in gaining access to health care resources. The care of Helga Wanglie, an elderly woman whose family insisted on continuing life support long after she had lapsed into a persistent vegetative state (PVS), cost approximately $750,000, the majority of which was paid by a Medi-gap policy purchased from a health maintenance organization (HMO). Similarly, Baby K was an anencephalic infant whose mother, believing that all life is precious regardless of its quality, insisted that the hospital where her daughter was born provide mechanical ventilation, including intensive care, whenever respiratory distress threatened her life. Over the hospital's objections, courts ruled that aggressive care must be provided. Much of Baby K's care was covered by her mother's HMO policy. In the 1993 case of Fox v. HealthNet, a jury awarded $89 million to the family of a woman whose HMO had refused, as experimental, coverage for autologous bone marrow transplant in treating her advanced breast cancer.

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