Vegetative state: symptoms, causes and treatment
We often listen, read, or even use terms whose meaning we are not completely sure of. By common sense we make arbitrary associations between a state and a term that is not always the one that correctly describes that state. This situation often occurs with the vegetative state , which is associated with the coma state or the state of minimal consciousness. But in reality these three are different, and we should be clear about their differences.
In this article we will know the most relevant aspects of the vegetative state, its possible causes and symptoms, as well as the treatments and care that are used for these cases .
What is the vegetative state?
It is determined that the person is in a vegetative state when the brain structures responsible for the higher mental functions have stopped functioning , but the structures of the brain that are responsible for the vital functions (sleep cycles, body temperature, respiration and heart rate).
This means the subject in a vegetative state will have vital signs and will give the impression of being awake, in a waking state, but it will not really respond to any stimulation of the environment, nor will it be able to speak, besides not having awareness of itself or of the others .
This circumstance represents one of the most rare and infrequent brain pathologies to occur, but when it occurs it is a permanent state. There are treatments that have apparently given results with some patients, causing them to recover brain functions after some time. But it has not been possible to determine if those patients were really in a vegetative state or only had a state of minimal consciousness.
Vegetative state causes
This condition occurs when there is significant damage to the upper part of the brain , making it impossible for the individual to have higher mental functions. However, the ascending and descending lattice systems (SARA and SIR) remain functional, taking care of the subject’s waking and sleeping states.
Some of the specific causes that can cause a vegetative state are especially a cranial trauma, a cardiac or respiratory arrest that prevents the arrival of oxygen to the brain. Hemorrhages or brain infections can also detonate the vegetative state in the individual .
Although the brain is affected in terms of its most significant functions, it still has the ability to act in certain areas of life , so that sometimes it may seem that the person is reacting in a conscious manner to the environment. But in reality these are basic primary reflexes, which have a specific response to some stimuli.
For example, patients in a vegetative state reach to clench their fists when they touch the palm of their hands . This does not mean that they do it deliberately, it is more like the palmar reflex of babies.
Other symptoms of the vegetative state are the following: they can open their eyes, they present apparently normal sleep behaviors; but they are not necessarily related to day and night, they are able to breathe, suck, chew, cough, choke, swallow and make sounds with the throat.
Although these behaviors may seem conscious, they do not really respond to any deliberate thoughts or intentions on the part of the patient .
When the cause of the vegetative state has been a traumatism of the skull and not a disease that diminishes the arrival of oxygen to the brain, minimal levels of consciousness of the electroencephalogram can be detected . For example, some patients may imagine that they move the upper limbs, but they are not able to actually do it. As for the physiological needs, they are completely involuntary in all cases.
For a correct diagnosis, it is necessary that the patient has undergone the corresponding medical evaluation , in addition to a nuclear magnetic resonance.
Apart from these evaluations, the observation must be constant for a significant period of time, in order to avoid that some signs of consciousness may be overlooked. Treatment
Taking into account that currently this state is not reversible , care and treatment are preventive, to prevent the physical situation of the subject can be affected to a greater extent.
What is done in these cases is to prevent the problems of immobilization and ensure that nutrition is correct.
The physiotherapist and the nutritionist usually provide support to the caregivers during the first days of care, indicating how the movements should be to help the patient and what the specific diet should be .
Depending on the laws of each country, there are measures about the suspension of vital supports during the vegetative state. This issue must be discussed by the hospital authorities together with the family members. In case the patient has left his wishes in writing, they must be taken into account at the time of the final decision.