COMA-UNRESPONSIVE WAKEFULNESS SYNDROME (UWS)

SUMMARY

1. Unresponsive wakefulness syndrome/vegetative state results from severe bilateral cerebral dysfunction, often following a period of coma.

2. May be caused by anoxic brain damage (e.g., after Ml), terminal phase of degenerative processes such as Alzheimer & CJD or trauma.

3. These patients typically have normal sleep-wake cycles but no discernible cognitive function (awake but not aware).

4. Respiration can quicken in response to stimulation, and there may be automatisms such as swallowing, bruxism, grimacing, grunting, and moaning. There is loss of sphincter control.

5. EEG abnormalities include low-amplitude delta-frequency background activity, burst suppression, widespread alpha and theta activity, an alpha coma pattern, and sleep spindles. Stimulating the patient causes minimal if any change in background EEG activity.

6. Vegetative state that persists more than 3 months is called persistent vegetative state. Patients who do not recover after 3 months are unlikely to recover (in cases of anoxic brain damage).

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].