Latronico N, Antonini L, Taricco M, Vignolo L A, Candiani A
II Servizio di Anestesia e Rianimazione, Università degli Studi di Brescia, Spedali Civili.
Minerva Anestesiol. 2000 Apr;66(4):233-40.
A prerequisite to the diagnosis of vegetative state is the exclusion of apparently similar syndromes, in which the patient retains the consciousness partially or even completely. Some syndromes are not separate nosological entities and should be abandoned: the apallic state, the neocortical death, the decerebrate and decorticate state, the alpha-coma, the vigil or prolonged or irreversible coma are among them. Three conditions deserve special consideration. The term locked-in syndrome describes a patient completely paralysed and mute, but fully conscious, and is usually caused by ischemic lesions of the pons. Several variants do exist, either in the causes and site of lesion. Some patients may become paralysed and mute, but conscious because of polyneuropathies, that is in the absence of any lesions of the central nervous system. The akinetic mutism is a rare condition characterised by loss of speech and nearly absent bodily movements. Painful stimulation may cause appropriate withdrawing, and wakefulness and self-awareness may be preserved, but cognitive impairment is usually present. It must be emphasised that this condition can be due to potentially treatable lesions, such as hydrocephalus and craniopharyngioma. The term "minimally responsive" or "minimally conscious" describes severely disabled patients in whom meaningful responses can be demonstrated, although inconstantly. This condition, the true diagnostic challenge, often represents a transition phase of vegetative patients recovering consciousness. Physicians, physiotherapists and patient's relatives should work all together to reach a correct diagnosis, by using current available methods to monitorize the recovery of consciousness.
诊断植物状态的一个前提是排除明显相似的综合征，在这些综合征中，患者部分甚至完全保留意识。有些综合征并非独立的病种实体，应予摒弃：去大脑皮质状态、新皮质死亡、去大脑强直和去皮层状态、α波昏迷、持续性或延长性或不可逆昏迷等都属于此类。有三种情况值得特别考虑。闭锁综合征一词描述的是患者完全瘫痪且缄默，但意识完全清醒，通常由脑桥缺血性病变引起。确实存在几种变体，病变的原因和部位各不相同。有些患者可能因多发性神经病而瘫痪和缄默，但意识清醒，即在中枢神经系统无任何病变的情况下。运动不能性缄默是一种罕见的病症，其特征是言语丧失和几乎没有身体活动。疼痛刺激可能会引起适当的退缩反应，清醒和自我意识可能得以保留，但通常存在认知障碍。必须强调的是，这种情况可能是由潜在可治疗的病变引起的，如脑积水和颅咽管瘤。“最小反应性”或“最小意识”一词描述的是严重残疾患者中，虽不经常但可表现出有意义反应的情况。这种情况是真正的诊断难题，往往代表植物人患者恢复意识的过渡阶段。医生、物理治疗师和患者家属应共同努力，通过使用现有的监测意识恢复的方法来做出正确诊断。
