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Vegetative state: causes, symptoms, diagnosis, treatment
Last reviewed: 07.07.2025

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Vegetative state is a prolonged, sleep-unrelated state of disorientation and unresponsiveness associated with extensive dysfunction of the cerebral hemispheres, but the diencephalon and brainstem provide vegetative and motor reflexes, as well as alternation of sleep-wake phases. Complex reflexes are usually preserved, including eye movements, yawning, involuntary movements in response to painful stimuli, but awareness of oneself and the surroundings is lost. Diagnosis is based on the clinical picture and duration of the condition. Prognosis is unfavorable, treatment is symptomatic. Discontinuation of treatment should be discussed with family members.
Unlike coma, in a vegetative state, the eyes can open and sleep and wakefulness can alternate, but there is also no awareness of the surroundings. In a vegetative state, the VARS remains functionally active, but the cerebral cortex is significantly damaged. With adequate treatment and care, the activity of the hypothalamus and brainstem is sufficient for the survival of patients.
Symptoms of a vegetative state
Signs of self-awareness and awareness of the surroundings do not appear, the patient cannot make contact. Stable, purposeful reactions to external stimuli, understanding and speech are absent.
There are signs of an intact VARS (eye opening, periods of wakefulness with irregular sleep-wake cycles) and an intact brainstem (eg, pupillary responses, oculocephalic reflex). Complex brainstem reflexes are present, including yawning, chewing, swallowing, and occasionally glottal sounds. Arousal and startle reflexes may be preserved, such that loud sounds and bright flashes of light may cause the eyes to open. The eyes are moist, and tear production is preserved. Spontaneous wandering eye movements - usually slow at a constant speed and without saccadic twitches - are often misinterpreted as conscious tracking, disorienting family members.
The limbs can move, but only within the framework of primitive purposeful motor reactions (for example, grasping an object that has touched the hand). Pain can provoke the adoption of decorticate and decerebrate postures or only pseudo-purposeful or non-purposeful avoidance reactions. Incontinence of urine and feces is characteristic. Cranial nerve functions and spinal reflexes are usually preserved.
The diagnosis is based on the typical clinical picture of symptoms and signs in the context of CNS involvement. Neuroimaging, EEG, and somatosensory evoked potentials usually do not add anything to the diagnosis.
Prognosis and treatment of vegetative state
Recovery from a vegetative state after 3 months of non-traumatic brain injury and 12 months of trauma is rare. At best, recovery involves a state of moderate to severe functional impairment. Rarely, improvement occurs at a later stage, such that after 5 years, the ability to communicate and comprehend may be restored in about 3% of cases, but a return to independence in everyday life is even rarer and no patient ever recovers to a normal state.
Most patients in a vegetative state die within 6 months due to lung infections, urinary tract infections, multiple organ failure, or sudden death of unknown cause. For the rest, life expectancy is 2-5 years, and some live for decades.
Treatment is aimed at preventing systemic disturbances (e.g. pneumonia, urinary tract infections), providing good nutrition, preventing pressure ulcers, and physical exercise to prevent the development of contractures in the limbs. Patients may not perceive pain, but respond to it with motor reflexes. Issues of care should involve social services, the hospital ethics committee, and frequent meetings with family members. Keeping a patient alive in a persistent vegetative state for more than 6 months, especially without a prognosis in terms of decisions about stopping treatment, raises social and ethical issues.