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For further information, see CMDT Part 24-23: Stupor & Coma

Key Features

  • Patients with severe bilateral hemispheric disease may show some improvement from an initially comatose state, so that, after a variable interval, they appear to be awake but display no movement

  • This is called a “persistent” vegetative state once it has lasted over 4 weeks and has also been variously referred to as akinetic mutism, apallic state, or coma vigil

  • Patients in a vegetative state from a medical cause (eg, anoxic brain injury) for more than 3 months and from a traumatic brain injury for more than 12 months are said to be in a chronic vegetative state, from which a few patients may regain consciousness but remain severely disabled

Clinical Findings

  • Patients appear to be awake with open eyelids but lie motionless

  • No evidence of awareness or higher mental activity

  • Simulate coma

  • Unresponsive

Diagnosis

  • Obtain the expertise of a clinician familiar with this syndrome to aid in the diagnosis

  • Now differentiated from the minimally conscious state

Treatment

  • Supportive care, palliative care

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