Clinical diagnosis of prolonged states of impaired consciousness in adults.

A prolonged state of impaired consciousness is a devastating consequence of severe structural brain injury but fortunately is uncommon. Patients may be diagnosed as being in a persistent vegetative state, having akinetic mutism, or being in a minimally conscious state. These conditions can be distinguished from each other by a comprehensive clinical neurologic examination. Recovery is determined by age, cause, and time in such state. For patients diagnosed as being in a permanent (irreversible) vegetative state, hope for a clinically meaningful recovery is unrealistic after 1 year. Prolonged survival is possible only with meticulous care and aggressive medical intervention to prevent and treat systemic complications.