Brain, Vol. 123, No. 7, 1327-1338,
July 2000
© 2000 Oxford University Press
The neuropathology of the vegetative state after an acute brain insult
1 University Departments of Neuropathology and 2 Neurosurgery, Institute of Neurological Sciences, South Glasgow University Hospitals NHS Trust, Glasgow, UK
Correspondence to:
J. Hume Adams, University Department of Neuropathology, Institute of Neurological Sciences, Southern General Hospital, South Glasgow University Hospitals NHS Trust, 1345 Govan Road, Glasgow G51 4TF, UK
The vegetative state is often described clinically as loss of function of the cortex while the function of the brainstem is preserved. In an attempt to define the structural basis of the vegetative state we have undertaken a detailed neuropathological study of the brains of 49 patients who remained vegetative until death, 1 month to 8 years after an acute brain insult. Of these, 35 had sustained a blunt head injury and 14 some type of acute non-traumatic brain damage. In the traumatic cases the commonest structural abnormalities identified were grades 2 and 3 diffuse axonal injury (25 cases, 71%). The thalamus was abnormal in 28 cases (80%), and in 96% of the cases who survived for more than 3 months. Other abnormalities included ischaemic damage in the neocortex (13 cases, 37%) and intracranial haematoma (nine cases, 26%). In the non-traumatic cases there was diffuse ischaemic damage in the neocortex in nine cases (64%) and focal damage in four (29%); the thalamus was abnormal in every case. There were cases in both groups where the cerebral cortex, the cerebellum and the brainstem were of structurally normal appearance. In every case, however, there was profound damage to the subcortical white matter or to the major relay nuclei of the thalamus, or both. These lesions render any structurally intact cortex unable to function because connections between different cortical areas via the thalamic nuclei are no longer functional, and there is also extensive damage to afferent and efferent cerebral connections.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  N. D. Schiff, J. T. Giacino, and J. J. Fins Deep Brain Stimulation, Neuroethics, and the Minimally Conscious State: Moving Beyond Proof of Principle Arch Neurol, June 1, 2009; 66(6): 697 - 702. [Full Text] [PDF]
|
|
|
|
 |
|
 N. D. Schiff Bringing neuroimaging tools closer to diagnostic use in the severely injured brain Brain, October 1, 2007; 130(10): 2482 - 2483. [Full Text] [PDF]
|
|
|
|
 |
|
 B. FURLOW Diagnostic Imaging of Traumatic Brain Injury. Radiol. Technol., November 1, 2006; 78(2): 145 - 156. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. D. Patrick, J. A. Blackman, J. L. Mabry, M. L. Buck, M. J. Gurka, and M. R. Conaway Dopamine Agonist Therapy in Low-Response Children Following Traumatic Brain Injury J Child Neurol, October 1, 2006; 21(10): 879 - 885. [Abstract] [PDF]
|
|
|
|
 |
|
 M R Coleman, D K Menon, T D Fryer, and J D Pickard Neurometabolic coupling in the vegetative and minimally conscious states: preliminary findings J. Neurol. Neurosurg. Psychiatry, March 1, 2005; 76(3): 432 - 434. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F Tomaiuolo, G A Carlesimo, M Di Paola, M Petrides, F Fera, R Bonanni, R Formisano, P Pasqualetti, and C Caltagirone Gross morphology and morphometric sequelae in the hippocampus, fornix, and corpus callosum of patients with severe non-missile traumatic brain injury without macroscopically detectable lesions: a T1 weighted MRI study J. Neurol. Neurosurg. Psychiatry, September 1, 2004; 75(9): 1314 - 1322. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K A Jellinger, W Matsuda, Y Komatsu, A Matsumura, and K Yanaka Parkinsonism and persistent vegetative state after head injury * Authors' reply J. Neurol. Neurosurg. Psychiatry, July 1, 2004; 75(7): 1082 - 1083. [Full Text] [PDF]
|
|
|
|
|
|
M Uzan, S Albayram, S G R Dashti, S Aydin, M Hanci, and C Kuday Thalamic proton magnetic resonance spectroscopy in vegetative state induced by traumatic brain injury J. Neurol. Neurosurg. Psychiatry, January 1, 2003; 74(1): 33 - 38. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B Jennett The vegetative state J. Neurol. Neurosurg. Psychiatry, October 1, 2002; 73(4): 355 - 357. [Full Text] [PDF]
|
|
|
|
|
|
N. D. Schiff, U. Ribary, D. R. Moreno, B. Beattie, E. Kronberg, R. Blasberg, J. Giacino, C. McCagg, J. J. Fins, R. Llinas, et al. Residual cerebral activity and behavioural fragments can remain in the persistently vegetative brain Brain, June 1, 2002; 125(6): 1210 - 1234. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 White matter hyperintensities and neuropsychological outcome following carbon monoxide poisoning Neurology, May 28, 2002; 58(10): 1525 - 1532.
|
|
|
|
 |
|
 I. M. Medana, N. P. Day, T. T. Hien, N. T. H. Mai, D. Bethell, N. H. Phu, J. Farrar, M. M. Esiri, N. J. White, and G. D. Turner Axonal Injury in Cerebral Malaria Am. J. Pathol., February 1, 2002; 160(2): 655 - 666. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J H. Adams, D I Graham, and B Jennett The structural basis of moderate disability after traumatic brain damage J. Neurol. Neurosurg. Psychiatry, October 1, 2001; 71(4): 521 - 524. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Jennett, J. H. Adams, L. S. Murray, and D. I. Graham Neuropathology in vegetative and severely disabled patients after head injury Neurology, February 27, 2001; 56(4): 486 - 490. [Abstract] [Full Text] [PDF]
|
|