Chronic wakefulness symptoms -
Magnetic resonance angiography can be used to visualize the cerebral vasculature after exclusion of a cerebral hemorrhage. Diffusion-weighted MRI is becoming the preferred imaging modality for following ongoing ischemic changes in the brain.
Positron emission tomography PET , functional MRI, and single-photon emission computed tomography SPECT can be used to assess cerebral function rather than brain anatomy. If the diagnosis of persistent vegetative state is in doubt, PET, SPECT, or functional MRI should be done.
In some cases, these tests can show whether parts of the brain, such as the cortex, are still functioning even if it is not evident during clinical examination. Prognosis varies somewhat by cause and duration of the vegetative state. Prognosis may be better if the cause is a reversible metabolic condition eg, toxic encephalopathy than if the cause is neuronal death due to extensive hypoxia and ischemia or another condition.
Also, younger patients may recover more motor function than older patients but not more cognition, behavior, or speech. Recovery from a vegetative state is unlikely after 1 month if brain damage is nontraumatic and after 12 months if brain damage is traumatic.
Even if some recovery occurs after these intervals, most patients are severely disabled. If a vegetative state persists, most patients die within 6 months of the original brain damage. The cause is usually pulmonary infection, urinary tract infection, or multiple organ failure, or death may be sudden and of unknown cause.
A few patients live for decades. Most patients tend to recover consciousness but to a limited extent depending on how long the minimally conscious state has lasted. The longer it has lasted, the less chance of patients recovering higher cortical function. Prognosis may be better if the cause is traumatic brain injury.
Rarely, patients regain clear but limited awareness after years of coma, called awakenings by the news media. Supportive care is the mainstay of treatment for patients in a vegetative state or minimally conscious state; it should include the following:.
Preventing systemic complications due to immobilization eg, pneumonia, urinary tract infection, thromboembolic disease. Preventing pressure ulcers Prevention Pressure injuries are areas of necrosis and often ulceration also called pressure ulcers where soft tissues are compressed between bony prominences and external hard surfaces.
They are caused Vegetative state has no specific treatment. Decisions about life-sustaining care should involve social services, the hospital ethics committee, and family members. Maintaining patients, especially those without advanced directives Advance Directives Advance directives are legal documents that extend a person's control over health care decisions in the event that the person becomes incapacitated.
They are called advance directives because read more to guide decisions about terminating treatment, in a prolonged vegetative state raises ethical and other eg, resource utilization questions.
Most patients in a minimally conscious state do not respond to specific treatments. However, in some cases, treatment with zolpidem , apomorphine , or amantadine can lead to improvement in neurologic responsiveness for as long as the drug is continued.
A growing number of studies are evaluating the effects of providing music interventions during disorders of consciousness 1 Treatment reference A vegetative state is absence of responsiveness and awareness due to overwhelming dysfunction of the cerebral hemispheres, with sufficient sparing of the diencephalon and brain stem to preserve Some studies show that music therapy may lead to positive behavioral effects and return to normal physiologic responses.
Results should be interpreted with caution because research in this area has thus far been limited. Li X, Li C, Hu N, Wang T : Music interventions for disorders of consciousness: A systematic review and meta-analysis.
J Neurosci Nurs 52 4 : —, doi: Vegetative state is typically characterized by absence of responsiveness and awareness due to overwhelming dysfunction of the cerebral hemispheres, intact brain stem function, and sometimes the simulation of awareness despite its absence.
They're usually able to move their eyes and are sometimes able to communicate by blinking. Page last reviewed: 27 May Next review due: 27 May Home Health A to Z Back to Health A to Z.
Overview - Disorders of consciousness Contents Overview Causes Diagnosis. Consciousness requires both wakefulness and awareness. The main disorders of consciousness are: coma vegetative state minimally conscious state Coma A coma is when a person shows no signs of being awake and no signs of being aware.
Read more about comas. Vegetative state A vegetative state is when a person is awake but is showing no signs of awareness. A person in a vegetative state may: open their eyes wake up and fall asleep at regular intervals have basic reflexes such as blinking when they're startled by a loud noise or withdrawing their hand when it's squeezed hard They're also able to regulate their heartbeat and breathing without assistance.
They also show no signs of experiencing emotions. If a person is in a vegetative state for a long time, it may be considered to be: a continuing vegetative state when it's been longer than 4 weeks a permanent vegetative state when it's been more than 6 months if caused by a non-traumatic brain injury, or more than 12 months if caused by a traumatic brain injury If a person is diagnosed as being in a permanent vegetative state, recovery is extremely unlikely but not impossible.
Minimally conscious state A person who shows clear but minimal or inconsistent awareness is classified as being in a minimally conscious state. But it's more difficult to diagnose a permanent minimally conscious state because it depends on things like: the type of brain injury how severe the injury is how responsive the person is In most cases, a minimally conscious state isn't usually considered to be permanent until it's lasted for several months and there have been no signs of improvement.
Why they happen Disorders of consciousness can occur if the parts of the brain involved with consciousness are damaged.
These types of brain injury can be divided into: traumatic brain injury — the result of a severe head injury , such as an injury sustained during a car accident or a fall from a great height non-traumatic brain injury — where the injury to the brain is caused by a health condition, such as a stroke progressive brain damage — where the brain is gradually damaged over time for example, because of Alzheimer's disease Read more about the causes of disorders of consciousness.
Making a diagnosis A disorder of consciousness will only be confirmed after extensive testing to determine the person's level of wakefulness and awareness. Treatment and care Treatment can't ensure recovery from a state of impaired consciousness.
This can involve: providing nutrition through a feeding tube making sure the person is moved regularly so they don't develop pressure ulcers gently exercising their joints to prevent them becoming tight keeping their skin clean managing their bowel and bladder for example, using a tube known as a catheter to drain the bladder keeping their teeth and mouth clean offering opportunities for periods of meaningful activity — such as listening to music or watching television, being shown pictures or hearing family members talking Sensory stimulation In some cases, a treatment called sensory stimulation may be used in an attempt to increase responsiveness.
Some examples of sensory stimulation include: visual — showing photos of friends and family, or a favourite film hearing — talking or playing a favourite song smell — putting flowers in the room or spraying a favourite perfume touch — holding their hand or stroking their skin with different fabrics It's not entirely clear how effective sensory stimulation is, but it's sometimes considered worthwhile.
Recovery It's impossible to predict the chances of someone in a state of impaired consciousness improving. It largely depends on: the type of brain injury how severe the injury is the person's age how long they have been in the state for Some people improve gradually, whereas others stay in a state of impaired consciousness for years.
Withdrawing nutritional support If a person is in a permanent vegetative state for 12 months after a traumatic brain injury, or 6 months after a non-traumatic brain injury, then it may be recommended to withdraw their nutritional support.
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Obstructive sleep apnea occurs when the muscles that support the soft tissues in your throat, such as your tongue and soft palate, temporarily relax. When these muscles relax, your airway is narrowed or closed, and breathing is momentarily cut off. This type of sleep apnea happens when the muscles in the back of the throat relax.
These muscles support the soft palate, the triangular piece of tissue hanging from the soft palate called the uvula, the tonsils, the side walls of the throat and the tongue.
When the muscles relax, your airway narrows or closes as you breathe in. You can't get enough air, which can lower the oxygen level in your blood. Your brain senses that you can't breathe, and briefly wakes you so that you can reopen your airway.
This awakening is usually so brief that you don't remember it. You might snort, choke or gasp. This pattern can repeat itself 5 to 30 times or more each hour, all night. This makes it hard to reach the deep, restful phases of sleep. This less common form of sleep apnea occurs when your brain fails to send signals to your breathing muscles.
This means that you make no effort to breathe for a short period. You might awaken with shortness of breath or have a difficult time getting to sleep or staying asleep. Sleep apnea is a serious medical condition. Complications of OSA can include:. Daytime fatigue.
The repeated awakenings associated with sleep apnea make typical, restorative sleep impossible, in turn making severe daytime drowsiness, fatigue and irritability likely.
You might have trouble concentrating and find yourself falling asleep at work, while watching TV or even when driving. People with sleep apnea have an increased risk of motor vehicle and workplace accidents. You might also feel quick-tempered, moody or depressed. Children and adolescents with sleep apnea might perform poorly in school or have behavior problems.
High blood pressure or heart problems. Sudden drops in blood oxygen levels that occur during OSA increase blood pressure and strain the cardiovascular system. Having OSA increases your risk of high blood pressure, also known as hypertension.
OSA might also increase your risk of recurrent heart attack, stroke and irregular heartbeats, such as atrial fibrillation. If you have heart disease, multiple episodes of low blood oxygen hypoxia or hypoxemia can lead to sudden death from an irregular heartbeat.
Complications with medicines and surgery. Obstructive sleep apnea is also a concern with certain medicines and general anesthesia. People with sleep apnea might be more likely to have complications after major surgery because they're prone to breathing problems, especially when sedated and lying on their backs.
The repeated awakening associated with sleep apnea makes typical, restorative sleep impossible. People with central sleep apnea often have severe fatigue, daytime drowsiness and irritability. You might have difficulty concentrating and find yourself falling asleep at work, while watching television or even while driving.
BMC Chronic wakefulness symptoms volume zymptomsCjronic number: Body composition tracking Cite this article. Metrics details. Some patients awaken from coma Nutritious food choices is, open the eyes but remain unresponsive that is, only showing reflex movements without response to command. This syndrome has been coined vegetative state. We here present a new name for this challenging neurological condition: unresponsive wakefulness syndrome abbreviated UWS. The Healing vegetable power wakefulness syndrome Chronic wakefulness symptomsNutritious food choices Holistic health supplement as the vegetative sykptoms, is one of the most wakefunless outcomes of acquired brain injury. Patients cheonic UWS open their chronic wakefulness symptoms spontaneously but symotoms only reflexive behavior; there symptoks no signs of consciousness, chronic wakefulness symptoms. Research shows that, for years now, wakefu,ness Netherlands Nutritious food choices the Nutritious food choices lowest symproms prevalence of UWS. Unfortunately, this small group of vulnerable patients does not receive the care it needs. Access to specialized rehabilitation is limited, misdiagnosis rates are high and a substantial number of UWS patients receive life-prolonging treatment beyond chances of recovery, despite a framework allowing for discontinuation of such treatment once recovery of consciousness has become unlikely. By comparing data from with that ofthis paper illustrates the current situation and outlook for UWS patients in the Netherlands and makes recommendations for the optimization of treatment and care, as well as for future research. Abstract The unresponsive wakefulness syndrome UWSformerly known as the vegetative state, is one of the most dramatic outcomes of acquired brain injury.
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