Etiology

Multiple etiologies may lead to the persistent vegetative state. The end result is severe neuronal loss of the cerebral hemispheres with sparing of at least the lower brain stem. Following an anoxic insult, CT may reveal diffuse cortical swelling and progress to hypodensities in both cerebral hemispheres. In animal models of persistent vegetative state induced by transient global brain ischemia, neurodegeneration of Purkinje cells and the hippocampal CA1 pyramidal cells represents the initial phase of cerebral damage. Postmortem examinations of vegetative patients have demonstrated the loss of forebrain and neocortical structures with an intact brain stem.

Cerebrovascular accidents, such as those secondary to cardiac arrest, or the progressive loss of cortical function, such as dementia, appear to be the most common causes of the persistent vegetative state, accounting for at least 63% of the cases in one study. In younger individuals, cerebral trauma is a common cause of persistent vegetative state. Trauma patients who progress to a vegetative state have been reported to sustain more severe closed-head injury and develop swelling or shift of midline structures. Metabolic disorders such as hypoglycemia can also result in the vegetative state.

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