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THE VEGETATIVE STATE AND ITS PROGNOSIS FOLLOWING NONTRAUMATIC COMA *

The vegetàtive state is a condition of wakefulness without awareness. Clinical features of 36 patients in coma who did not improve beyond the vegetative state in one month were evaluated as part of an international collaborative prospective study of 310 patients with nontraumatic coma. The vegetative group included 22 subjects with diffuse hypoxia‐ischemia, seven with focal brain infarction, two with brain hemorrhages, one each with subarachnoid hemorrhage, infection, and cerebral herniation caused by tumor, and two in whom the precise cause of coma was unknown. The vegetative group had signs of good brain‐stem function but little function of cerebral cortex. Many patients awakened quickly after the onset of coma: five opened their eyes within one day, 13 within three days, and 16 within one week. Roving conjugate eye movements were prominent. Nineteen of the 36 vegetative patients died within one month; 32 died by the end of one year. Only two patients ever regained any evidence of psychological self‐awareness (both improving within three months), but both remained completely dependent for daily care. Patients in coma may develop the vegetative state within a few days, but if they are still vegetative after a month, the chance of regaining independence is negligibly small.