Voor professionals

Abstract

Background
The vegetative state, also known as the unresponsive wakefulness syndrome, is one of the worst possible  outcomes of acquired brain injury and confronts rehabilitation specialists with various challenges. Emergence to (minimal) consciousness is classically considered unlikely beyond 3–6 months after non-traumatic or 12 months after traumatic etiologies. A growing body of evidence suggests that these timeframes are too narrow, but evidence regarding chances of 
recovery is still limited.

Objective
To identify the moment of recovery of consciousness in documented cases of late emergence from a vegetative state.

Methods
Four cases of apparent late recovery of consciousness, identifed within a prospective cohort study, were studied in-depth by analyzing medical, paramedical and nursing fles and interviewing the patients’ families about their account of the process of recovery.

Results
All patients were found to have shown signs of consciousness well within the expected time frame (5 weeks–2 months post-ictus). These behaviors, however, went unnoticed or were misinterpreted, leading to a diagnostic delay of several months to over 5 years. Absence of appropriate diagnostics, the use of erroneous terminology, sedative medication but also patientrelated factors such as hydrocephalus, language barriers and performance fuctuations are hypothesized to have contributed to the delay.

Conclusions
Delayed recognition of signs of consciousness in patients in a vegetative state may not only lead to suboptimal clinical care, but also to distorted prognostic fgures. Discriminating late recovery from the delayed discovery of consciousness, therefore, is vital to both clinical practice and science.