Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Radboudumc, ELG 117, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
Coma Science Group, GIGA Consciousness, Université de Liège, Liège, Belgium.
J Neurol. 2019 Dec;266(12):3144-3149. doi: 10.1007/s00415-019-09542-3. Epub 2019 Sep 20.
The vegetative state, also known as the unresponsive wakefulness syndrome, is one of the worst possible outcomes of acquired brain injury and confronts rehabilitation specialists with various challenges. Emergence to (minimal) consciousness is classically considered unlikely beyond 3-6 months after non-traumatic or 12 months after traumatic etiologies. A growing body of evidence suggests that these timeframes are too narrow, but evidence regarding chances of recovery is still limited.
To identify the moment of recovery of consciousness in documented cases of late emergence from a vegetative state.
Four cases of apparent late recovery of consciousness, identified within a prospective cohort study, were studied in-depth by analyzing medical, paramedical and nursing files and interviewing the patients' families about their account of the process of recovery.
All patients were found to have shown signs of consciousness well within the expected time frame (5 weeks-2 months post-ictus). These behaviors, however, went unnoticed or were misinterpreted, leading to a diagnostic delay of several months to over 5 years. Absence of appropriate diagnostics, the use of erroneous terminology, sedative medication but also patient-related factors such as hydrocephalus, language barriers and performance fluctuations are hypothesized to have contributed to the delay.
Delayed recognition of signs of consciousness in patients in a vegetative state may not only lead to suboptimal clinical care, but also to distorted prognostic figures. Discriminating late recovery from the delayed discovery of consciousness, therefore, is vital to both clinical practice and science.
植物状态，也称为无反应性觉醒综合征，是获得性脑损伤中最糟糕的结果之一，给康复专家带来了各种挑战。非创伤性病因后 3-6 个月或创伤性病因后 12 个月，经典地认为出现（最小）意识的可能性不大。越来越多的证据表明这些时间框架过于狭窄，但关于恢复机会的证据仍然有限。
确定从植物状态中明显晚期苏醒的记录病例中意识恢复的时刻。
通过分析医疗、辅助医疗和护理档案，并采访患者家属关于他们对恢复过程的描述，深入研究了一项前瞻性队列研究中确定的 4 例明显晚期意识恢复的病例。
所有患者均被发现早在预期时间范围内（中风后 5 周-2 个月）出现了意识迹象。然而，这些行为被忽视或被误解，导致诊断延迟了数月至 5 年以上。缺乏适当的诊断、使用错误的术语、镇静药物以及患者相关因素，如脑积水、语言障碍和表现波动，都被假设为导致这种延迟的原因。
对植物状态患者的意识迹象的延迟识别不仅可能导致临床护理不佳，还可能导致预后数据的扭曲。因此，将晚期意识恢复与意识发现的延迟区分开来，对临床实践和科学都至关重要。
