scholarly journals Persistent vegetative state after traumatic brain injury - a case report and review of the literature

2014 ◽  
Vol 13 (3) ◽  
pp. 358-365 ◽  
Author(s):  
Mohammad Yousuf Rathor ◽  
Mohammad Fauzi Abdul Rani ◽  
TCA Shahrin ◽  
HZ Hashim
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Vegetative State ◽  
Medical Science ◽  
Persistent Vegetative State ◽  
Disorder Of Consciousness ◽  
End Of Life Decisions ◽  
The Past ◽  
Late Recovery ◽  
Behavioural Evidence

Persistent vegetative state (PVS) is a chronic neurological disorder of consciousness, in which patients appear to be awake, but show no behavioural evidence of awareness. It cannot be diagnosed with certainty and misdiagnosis is very frequent. Its management has become one of the most controversial and emotive issues in medical ethics and medical law over the past few decades. The results of recent neuroimaging studies along with well-documented reports of significant late recovery of some PVS patients have challenged the long-held view that restoration of function in the severely traumatic brain injury (TBI) patients is not possible. Some clinicians believe that PVS is a misused term with the potential consequences of withdrawal and withholding of care, and tendency towards less aggressive management. Further naming these patients as “vegetative” has been misinterpreted by many groups that the patient is no more a human but “vegetable” like.  Recently there has been an attempt to replace PVS by new, more appropriate name "Unresponsive Wakefulness Syndrome" (UWS). As opposed to brain death, PVS is not recognized by statute as death in any legal system.  The context within which end of life decisions are being made for these patients has led to outrage especially if decisions were made to terminate hydration and nutrition. We present a case of young boy who is in a PVS following TBI with the aim to review some of the contemporary issues regarding their management. DOI: http://dx.doi.org/10.3329/bjms.v13i3.19159 Bangladesh Journal of Medical Science Vol.13(3) 2014 p.358-365

scholarly journals Circadian Blood Pressure and Heart Rate Changes in Patients in a Persistent Vegetative State After Traumatic Brain Injury

2005 ◽  
Vol 7 (12) ◽  
pp. 734-739 ◽  
Author(s):  
Paolo Pattoneri ◽  
Giovanni Tirabassi ◽  
Giovanna Pelà ◽  
Ettore Astorri ◽  
Anna Mazzucchi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Traumatic Brain Injury ◽  
Heart Rate ◽  
Brain Injury ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Circadian Blood Pressure

scholarly journals Patterns and Outcome of Traumatic Brain Injury Patients: A Study in a Tertiary Level Military Hospital

2020 ◽  
Vol 15 (1) ◽  
pp. 75-78
Author(s):  
Md Shohidul Islam ◽  
Md Fashiur Rahman ◽  
Md Aminul Islam
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Brain Injuries ◽  
Surgical Intervention ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Public Health Problem ◽  
Armed Forces ◽  
Military Hospital

Introduction: A traumatic brain injury (TBI) is an injury to the brain caused by an impact to the head. TBI represents a huge global medical and public health problem across all ages and in both civilian and military populations. TBI is characterized by great heterogeneity in terms of etiology, mechanism, pathology, severity and treatment with widely varying outcomes. Objective: To determine the pattern and outcome of traumatic brain injuries in victims reported to emergency and casualty (E&C) department following intensive care with or without surgical intervention. Materials and Methods: This prospective type of observational study was conducted at Neurosurgery department of Combined Military Hospital, Dhaka from October 2013 to March 2017. A total of 675 head injury patients with TBI were assessed with gender, age, cause and type of trauma, GCS on admission, associated other injuries, time lapsed from trauma to hospitalization and care given. The outcome was measured after 72 hours using Glasgow Outcome Scale (GOS). Results: The incidence of TBI was 47.03% among the head injury patients. Common age group was 21-30 years (43.7%) and male victims (66.55%). RTA was the most frequent cause (50.05%) of TBI and the most common pathophysiological cause of TBI was subdural haemorrhage (SDH)(35%) followed by extradural haemorrhage (EDH)(27%). Most patients (45%) had mild TBI. Surgical intervention was required in 45% patients of TBI mainly for the SDH, EDH which had significant positive effect on the TBI patient’s outcome. The majority of patients (77%) had good outcome which included recovery (51.85%) and moderate disability (25.48%). The poor outcome was observed in 23% patients which included death (7.40%), persistent vegetative state (3.11%), severe disability (12.14%) and it was associated with older age, severe TBI (GCS<8 on admission), associated other injuries and delayed resuscitative care and interventions. Conclusion: TBI was common among the young adults male. The RTA was the leading cause of TBI. The factors that influence the outcome of TBI include patient’s age, severity of TBI, associated injuries and delayed resuscitative care. Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 75-78

scholarly journals Complications of decompressive craniectomy for traumatic brain injury

2009 ◽  
Vol 26 (6) ◽  
pp. E7 ◽  
Author(s):  
Shirley I. Stiver
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Decompressive Craniectomy ◽  
Perioperative Complications ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Surgical Decompression ◽  
Cerebral Herniation ◽  
Life Threatening ◽  
Detailed Search

Decompressive craniectomy is widely used to treat intracranial hypertension following traumatic brain injury (TBI). Two randomized trials are currently underway to further evaluate the effectiveness of decompressive craniectomy for TBI. Complications of this procedure have major ramifications on the risk-benefit balance in decision-making during evaluation of potential surgical candidates. To further evaluate the complications of decompressive craniectomy, a review of the literature was performed following a detailed search of PubMed between 1980 and 2009. The author restricted her study to literature pertaining to decompressive craniectomy for patients with TBI. An understanding of the pathophysiological events that accompany removal of a large piece of skull bone provides a foundation for understanding many of the complications associated with decompressive craniectomy. The author determined that decompressive craniectomy is not a simple, straightforward operation without adverse effects. Rather, numerous complications may arise, and they do so in a sequential fashion at specific time points following surgical decompression. Expansion of contusions, new subdural and epidural hematomas contralateral to the decompressed hemisphere, and external cerebral herniation typify the early perioperative complications of decompressive craniectomy for TBI. Within the 1st week following decompression, CSF circulation derangements manifest commonly as subdural hygromas. Paradoxical herniation following lumbar puncture in the setting of a large skull defect is a rare, potentially fatal complication that can be prevented and treated if recognized early. During the later phases of recovery, patients may develop a new cognitive, neurological, or psychological deficit termed syndrome of the trephined. In the longer term, a persistent vegetative state is the most devastating of outcomes of decompressive craniectomy. The risk of complications following decompressive craniectomy is weighed against the life-threatening circumstances under which this surgery is performed. Ongoing trials will define whether this balance supports surgical decompression as a first-line treatment for TBI.

Cerebral acid—base homeostasis after severe traumatic brain injury

2005 ◽  
Vol 103 (4) ◽  
pp. 597-607 ◽  
Author(s):  
Tobias Clausen ◽  
Ahmad Khaldi ◽  
Alois Zauner ◽  
Michael Reinert ◽  
Egon Doppenberg ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Brain Tissue ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Acid Base ◽  
Content Type ◽  
Time Points ◽  
Tissue Acidosis ◽  
Fine Print

Object. Brain tissue acidosis is known to mediate neuronal death. Therefore the authors measured the main parameters of cerebral acid—base homeostasis, as well as their interrelations, shortly after severe traumatic brain injury (TBI) in humans. Methods. Brain tissue pH, PCO2, PO2, and/or lactate were measured in 151 patients with severe head injuries, by using a Neurotrend sensor and/or a microdialysis probe. Monitoring was started as soon as possible after the injury and continued for up to 4 days. During the 1st day following the trauma, the brain tissue pH was significantly lower, compared with later time points, in patients who died or remained in a persistent vegetative state. Six hours after the injury, brain tissue PCO2 was significantly higher in patients with a poor outcome compared with patients with a good outcome. Furthermore, significant elevations in cerebral concentrations of lactate were found during the 1st day after the injury, compared with later time points. These increases in lactate were typically more pronounced in patients with a poor outcome. Similar biochemical changes were observed during later hypoxic events. Conclusions. Severe human TBI profoundly disturbs cerebral acid—base homeostasis. The observed pH changes persist for the first 24 hours after the trauma. Brain tissue acidosis is associated with increased tissue PCO2 and lactate concentration; these pathobiochemical changes are more severe in patients who remain in a persistent vegetative state or die. Furthermore, increased brain tissue PCO2 (> 60 mm Hg) appears to be a useful clinical indicator of critical cerebral ischemia, especially when accompanied by increased lactate concentrations.

scholarly journals Islamic perspective on end of life issues in persistent vegetative state patients - a case report

2018 ◽  
Vol 17 (2) ◽  
Author(s):  
Mohammad Yousuf Rathor ◽  
Dr Che Rosle Draman
Keyword(s):  
Traumatic Brain Injury ◽  
Case Report ◽  
Brain Injury ◽  
Ethical Issues ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Islamic Perspective ◽  
Life Issues ◽  
Life Sustaining Treatment ◽  
End Of Life Issues

Persistent vegetative state (PVS) is a clinical condition of unawareness of self and environment with preserved sleep-wake cycles. Its clinical diagnosis can be a difficult unless a physician has adequate experience and expertise in evaluating neurological syndromes. Outcome is based on aetiology and age. Decisions on limiting life-sustaining treatment (LST) for these patients are emotionally and morally challenging. We present a case of a young boy who went into PVS following traumatic brain injury (TBI) with the aim to review some of the ethical issues regarding its management from Islamic perspective.

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