The report by Monti etal. (Feb. 18 issue) has raised concern worldwide among relatives of patients in a persistent vegetative state. Could their loved ones be conscious after all?However, in addressing such concerns, perhaps the mechanism of brain injury should be considered. It is worthwhile noting that all five patients who were in a vegetative or minimally conscious state and were found to be responsive on functional magnetic resonance imaging (MRI) were comatose as a result of traumatic brain injury rather than anoxic brain injury. The mechanism of injury differs between these two conditions. Multifocal damage with diffuse axonal injury occurs in traumatic injury, whereas in anoxic injury a diffuse anoxic cascade results in toxic metabolite formation, cell death, and loss of vasogenic regulation.
展开▼
