Persistent Vegetative State (pvs): From 1 Different Sources
PVS may occur in patients with severe brain damage from HYPOXIA or injury. Patients do not display any awareness of their surroundings, and are unable to communicate. Sleep alternates with apparent wakefulness, when some re?exes (see REFLEX ACTION) may be present: for example, patients’ eyes may re?exly follow or respond to sound, their limbs can re?exly withdraw from pain, and their hands can re?exly grope or grasp. Patients can breathe spontaneously, and retain normal heart and kidney function, although they are doubly incontinent (see INCONTINENCE).
For a diagnosis of PVS to be made, the state should have continued for more than a prede?ned period, usually one month. Half of patients die within 2–6 months, but some can survive for longer with arti?cial feeding. To assess a person’s level of consciousness, a numerical marking system rated according to various functions – eye opening, motor and verbal responses – has been established called the GLASGOW COMA SCALE.
The ETHICS of keeping patients alive with arti?cial support are controversial. In the UK, a legal ruling is usually needed for arti?cial support to be withdrawn after a diagnosis of PVS has been made. The chances of regaining consciousness after one year are slim and, even if patients do recover, they are usually left with severe neurological disability.
PVS must be distinguished from conditions which appear similar. These include the ‘LOCKED-IN SYNDROME’ which is the result of damage to the brain stem (see BRAIN). Patients with this syndrome are conscious but unable to speak or move except for certain eye movements and blinking. The psychiatric state of CATATONIA is another condition in which the patient retains consciousness and will usually recover.
Long-term unconsciousness caused by damage to areas of the brain that control higher mental functions. The eyes may open and close, and there may be random movements of the limbs, but there is no response to stimuli such as pain. Basic functions such as breathing and heartbeat are not affected. There is no treatment to reverse the situation, but, with good nursing care, survival for months or years is possible.... persistent vegetative state
See NEUROSIS.... anxiety state
Diarrhoea that begins acutely but lasts more than 21 days. The usual enteropathogens are Shigella spp., Salmonella spp., Campylobacter jejuni, Yersinia enterocolitica, Capillaria philippinensis, Cryptosporidium. Giardia can also be a cause.... persistent chronic diarrhoea
Major government schemes to ensure adequate health services to substantial sectors of the community through direct provision of services.... state medicine (health care systems)
See glue ear.... middle-ear effusion, persistent
(ASSR) an objective test of hearing that measures the electrical activity in the auditory nerve and *brainstem following sound stimulation using a modulated continuous tone.... auditory steady state response
(HHS) a state of extreme hyperglycaemia seen in type 2 diabetes accompanied by dehydration that can be severe, typically triggered by illness in a patient with type 2 diabetes or a patient with previously unknown type 2 diabetes. It was previously known as hyperosmolar non-ketotic hyperglycaemia (HONK). Emergency hospital treatment is required to control blood glucose levels and to treat the dehydration and the underlying precipitating cause. There is a significant mortality, especially in the elderly and patients with other disorders (e.g. vascular disease). While insulin is required as part of the initial emergency treatment, the patient often does not need insulin in the longer term, when well.... hyperosmolar hyperglycaemic state
(MSE) a full psychiatric examination of signs and symptoms, which takes place during a psychiatric interview and should apply only to signs and symptoms elicited at that time; it should not take into account historical information. The examination is usually divided into the following subheadings: appearance and behaviour, speech, mood, *affect, thought and perception, *insight, and orientation. Usually it also includes a *risk assessment.... mental state examination
(MCS) a disorder of consciousness distinct from *persistent vegetative state (PVS) and locked-in syndrome (see vegetative state). Unlike PVS, patients with MCS have partial preservation of conscious awareness although the level of awareness frequently fluctuates over time.... minimally conscious state
(MMSE) a brief 30-point questionnaire that is used to screen for cognitive impairment in the diagnosis of dementia. It is also used to estimate the severity of cognitive impairment and to follow the course of cognitive changes in an individual over time, thus making it an effective way to document response to treatment. It tests functions including arithmetic, memory, and orientation.... mini-mental state examination
a state of disordered mood that combines elements of *mania and *depression; it is a common feature of *bipolar affective disorder. Symptoms include overactivity, flight of ideas, depressed mood, and suicidal *ideation.... mixed affective state
(atypical facial pain, chronic idiopathic facial pain) a chronic pain in the face that has no known cause and does not fit the classic presentation of other cranial neuralgias. It may be stress-related, and in some cases appears to be associated with defective metabolism of *tyramine. Treatment may involve the use of antidepressants.... persistent idiopathic facial pain
adj. 1. relating to growth and nutrition rather than to reproduction. 2. functioning unconsciously; autonomic.... vegetative
the clinical condition of unawareness of the self or the environment. The patient breathes spontaneously and has a stable circulation and sleep/wake cycles. It results from extensive damage to the cerebral cortex and thalamus while the brainstem and hypothalamus remain intact. The commonest causes are traumatic brain injury (e.g. road-traffic accidents) and cardiopulmonary arrest. Conditions that mimic the vegetative state include the psychiatric state of *catatonia and the locked-in syndrome, resulting from damage to the brainstem, in which the patient is conscious but unable to speak or make any movements of the body except for blinking and upward eye movements. See also persistent vegetative state.... vegetative state
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