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Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.
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Subject: Re: Persistant Vegatative State (PVS) - severe damage to Brain Stem I hope you don't mind me putting my question to you even though I live in England, but I am at a loss as to where to get more information. Approximately 4 weeks ago (it seems like a lifetime) my 5 year old nephew (Bradley) went to the dentist to have a tooth removed by general anaesthetic because he was scared to have a local. Five minutes into the procedure he suffered a cardiac arrest,for some unknown reason the anaesthetist/dentist or whoever was responsible at the clinic, was unable to resuscitate him and called for an ambulance, well the long and short of it is that it took 40 minutes for him to be resuscitated - and obviously due to the lack of oxygen to his brain a serious amount of damage has been done. Bradley was on life support for about 14 days, when it was suggested that they should consider turning off the machine and letting nature take it's cause. Their reasoning behind this was that due to the amount of time it took to resuscitate him the Brain Stem has been so severely damaged that they feel (the Doctors and Consultants) there would be no way back for Bradley and basically he would not be able to function. My sister and her husband agreed to take him off the machine and he remained in hospital for a few days, when it was suggested that perhaps my sister would like to take him home (basically they meant to die!). Well, this is where we are at - he has been at home for about 2 weeks and is still hanging on in there - he is being tube fed and is on morphine and having drugs to dry up his chest fairly regularly. The nurses seem to think he should have died by now and have basically insinuated that my sister is caring for him too well!!! Bradley has his eyes open (although we are sure he can not focus) - he blinks and he does seem to have some recognition of voices - although again the Doctors have said that he cannot hear - but we know that hearing is the last sense to go and we don't necessarily agree with their opinion on this one. When he was in hospital we were told that he had no "cough, swallow or gag reflex" and that he would be unable to clear his throat, so my sister has been having to do this with a tube every now and then. However, during the last week several family visitors have seen him cough quite clearly and strongly - and this has made us unsure as to whether he will eventually have more of a chance. What I am really asking is does anyone have any knowledge of persistant/permanent vegatative state - as this is what he appears to be in. I spoke to my sister today (she lives 150 miles from me - so I have been up and down to see her when I can) and she says he has started to have little fits - quite often throughout the day, and the Doctor has been in and upped his morphine levels. If he is fitting does this not mean that some messages are getting through to the brain?? We were told originally that although there was only slight brain activity that some of this up to a period of about a year, may come back - but when they discovered the seriousness of the brain stem damage, they said it wouldn't make any difference as the messages wouldn't get through. Do you know of any miracles?? - or am I hanging on to false hope - as I say some of the family are sure he recognises us. His body is absolutely rigid and my sister and husband have to do physiotherapy on him twice or three times a day - which he seems to react to sometimes in pain. Again, the doctors are saying he doesn't feel any pain - so why treat him with morphine??? - Please help me to have some understanding of this situation. We don't want to be too optimistic if this is not realistic - but obviously we do not want to just give up on him!! Thanks for any help you can give me - or lead me to someone who can help. Liane
You are certainly asking here delicate questions. Firstly, the prognosis of a vegetative state can be difficult to determine. Bradley is very young, and this could give him more chance to have some degree of recovery. On the other hand, vegetative states caused by anoxia tend to have a less favorable outcome compared to vegetative states from other causes. The prognostic value of tests performed early after the event has not always been clearly demonstrated. Results from recent studies suggest that, if no improvement is observed within 3 months after the anoxia, chances of recovery could be considered very slim or inexistant. There has been no documented case of recovery after 2 years in the United States. Unfortunately, the fact that Bradley is able to cough does not mean that he is recovering, because this is only a reflex activity. Also, the fact that he has fits does not mean that he is improving. It is important to look for any sign of perception of the environment. Because they spend a lot of time with Bradley, family members have more chance to observe an intermittent improvement, but this has to be confirmed by a health professional, because some reflex behaviors can be misinterpreted and bring false hopes. The effect of environmental stimulations on recovery is controversial. A total absence of stimulations is certainly not recommended, but on the other hand some people think that very intensive stimulations are not beneficial, or could even have a negative impact.
As you see, many questions regarding vegetative states have not been answered yet. Statistics do not always help to make decisions for an individual person, because all cases are not similar. I hope my answer helped you a little, although it is difficult to be specific without being involved in the care of Bradley. If you have this possibility, you can ask for a second opinion. Also, there might be one or several associations of families of patients in vegetative state in the UK, which could provide your sister and her husband with information and support. | |
