Persistent vegetative and minimally conscious states.

The diagnosis and management of patients with persistent vegetative (PVS) and minimally conscious (MCS) states entail powerful medical, ethical and legal debates. The recent description of the MCS highlights the crucial role of unexpected and well-documented recoveries of cognitive functions. Functional neuroimaging has provided new insights for assessing neuropathology and cerebral activity in these patients, providing information on the presence, degree, and location of any residual brain function in patients with PVS or MCS.

Irreversibility: cardiac death versus brain death.

The acceptance of brain death (BD) as death of the human being has been progressively accepted beginning in the early 1960s. The issue of irreversibility is directly related to the diagnosis of human death, and it is closely associated with the concept of potentiality, i.e.

Brain anatomy, cerebral blood flow, and connectivity in the transition from PVS to MCS.

Background: We report a 15 year-old girl with sickle cell disease, who developed important cognitive impairment due to multiple strokes, and who had been diagnosed with PVS. Nonetheless, when she was later admitted to our Institute, according to the presence of inconsistent but clearly demonstrable behavioral evidence of consciousness awareness, we changed our diagnosis to MCS.

Methods: This patient was studied by T1 MRI images, co-registration of fractional anisotropy (FA), and SPECT with MRI.