Is the patient in a persistent vegetative state and is this the same as a persistent coma

My mother-in-law suffered a hemorrhagic stroke and as part of her treatment she was placed in a drug induced coma.  The sedation has been removed for over three weeks and she is still "sleeping."  There is also considerable swelling in the brain and the response to medication is insignificant so far.  The doctors discussed with my husband that the side of her brain affected by the stroke is completely dead and the real possibility that she may never walk or talk again.  My husband is insisting that the doctors did not say she was in a coma and because she sometimes twitches her hands and feet he thinks it is a sign that she is waking up.  She is 70 years old and also has high blood pressure and diabetes.  Am I wrong to think of her as being in a persistent coma?  Isn't that what the health care professionals have been telling my husband albeit in a softer, more gentle way?  Please let me know.  Thank you

[Bhupinder Kaur, MD]

Hello,

Coma is a state of unconsciousness whereby a patient cannot react with the surrounding environment. The patient cannot be wakened with outside physical or auditory stimulation.

The brain is divided into two hemispheres:right and left cerebral hemispheres by superior sagital sinus. The reticular activating system (RAS) is located within the brain stem and is the important "on/off" switch of the brain. To be awake, the reticular activating system (RAS) must be functioning, as well as at least one cerebral hemisphere.

If a person loses consciousness, either the RAS has stopped working, or both cerebral hemispheres have shut down.Doctors have said that one side of the brain is completely dead.Moreover there is edema of the brain.As the skull is a rigid box,so there is no room for the additional fluid. This causes the brain to push up against the sides of the skull and it then compresses. Unless the pressure is relieved, the brain will continue to swell until it pushes down onto the brain steam, which then damages the RAS, which subsequently affects blood pressure and breathing control centers.Lack of oxygen even for 4-6 minutes causes death or ischaemia of that portion of the brain.Hence the person may become brain dead in a couple of minutes if the edema is uncontrollable.
  
There is a Glasgow coma scale which is used for the assessment of brain injury and stroke patients. The GCS score will be documented; the deeper the coma, the lower the score.You can learn more about this score from the following website:
http://www.medicinenet.com/coma/page6.htm

So whether your mother in law will wake up from the sleep or not,depends on her GCS score and whether oxygen and blood supply to the brain is adequate or not.

Pls do post us in case of any additional queries.

Take care and God bless.

[wofie]

Thank you so much. They removed the ventilator but she has a tracheotomy (unsure of the spelling) and is receiving oxygen.  I guess this is instrumental in slowing the deterioration in the brain.  I will visit the suggested website and try to expand my knowledge in this area.  Again, thank you.