A vegetative state, or unaware and unresponsive state, is a specific neurological diagnosis in which a person has a functioning brain stem but no consciousness or cognitive function.
Individuals in an unaware and unresponsive state alternate between sleep and wakefulness. However, even when awake, they aren’t capable of interacting with other people or their surroundings.
Read on as we explore the causes of this neurological state, how it differs from coma or brain death, and how it’s diagnosed and treated.
If you have a loved one who’s in an unaware and unresponsive state, doctors may refer to it as a “vegetative” state.
But variations of this term have been used in ways to insult or hurt others. Because of the confusion and pain it may cause loved ones, neurologists are
searchingfor a better termfor this state of consciousness.
One such term is “unaware and unresponsive state,” which we will use in this article.
A person in an unaware and unresponsive state has experienced injury to the brain. They have no cognitive function, or ability to think. But since their brain stem is still functioning, the person may:
- regulate breathing and heart rate without assistance
- open their eyes
- have a sleep-wake cycle
- have basic reflexes
- move their eyes, blink, or tear up
- moan, grunt, or appear to smile
They’re not able to:
- follow objects with their eyes
- respond to voices or verbal commands
- speak or communicate through blinking or gesturing
- move with purpose
- interact with their surroundings
- show signs of emotion
- show signs of awareness
This unaware and unresponsive state differs from these similar conditions:
- Minimally conscious state. The person alternates between awareness and lack of awareness.
- Coma. The person is not awake or aware.
- Brain death. Damage to the brain and brain stem are categorically irreversible.
- Locked-in syndrome. The person is conscious and fully aware but fully paralyzed and unable to speak.
Diagnosis of an unaware and unresponsive state requires:
- presence of a sleep-wake cycle
- no language expression or comprehension
- no evidence of sustained, reproducible, purposeful, or voluntary response to stimulation of sight, sound, smell, or touch
- a functioning brain stem
Some of this information will come from direct observation by a neurologist.
A neurologist may also use diagnostic testing to confirm the diagnosis. These tests may include:
- EEG (electroencephalogram) to evaluate electrical activity in the brain
- CT or MRI scan to help assess damage to the brain and brain stem
- PET scan to help assess cerebral function
An unaware and unresponsive state
typicallyfollows a coma.
Acute brain damage due to illness or injury causes an unaware and unresponsive state.
Nontraumatic brain injury
This type of brain injury can occur when the brain is deprived of oxygen, or brain tissue is damaged. Some reasons for this include:
- drug overdose
- heart attack
- near drowning
- ruptured aneurysm
- smoke inhalation
Traumatic brain injury (TBI)
This type of brain injury is the result of injury you might get from a powerful blow to the head due to a:
- car accident
- fall from a great height
- workplace or athletic accident
Progressive brain damage
This brain injury may be due to conditions such as:
In life-threatening circumstances, doctors have the option of inducing a coma. This is to protect the brain and give it time to heal. However, the unresponsive and unaware stated is not medically induced.
There’s no real treatment. Rather, the focus is supportive care so the brain can heal. The person will be carefully monitored for changes or signs of improvement.
In addition, doctors will take steps to prevent potential complications, such as:
Supportive care may involve:
- a feeding tube to provide nutrients
- changing positions on a regular basis to avoid pressure sores
- physical therapy to gently exercise the joints
- skin care
- oral care
- management of bowel and bladder functions
Various specialists may involve family members in trying to stimulate the senses and prompting a response by:
- talking to them about things they’re familiar with
- playing music, TV, or favorite movies
- showing family pictures
- adding flowers, favorite perfumes, or other scents to the room
- holding or stroking their hand or arm
Treatment will begin in an acute care hospital setting. In some cases, the person may be transitioned to a nursing home or other long-term care facility.
A brain injury that results in an unaware and unresponsive state can happen to anyone. When it occurs during pregnancy, it requires careful evaluation of both mother and baby.
In one documented case, a pregnant woman entered this state at 14 weeks gestation. She was given supportive care and had a caesarean delivery at 34 weeks. The baby was healthy. The mother remained in an unaware and unresponsive state for another month before she died.
In another case, a woman was about 4 weeks pregnant when she entered an unaware and unresponsive state. With care, she was able to carry the fetus for another 29 weeks.
Following premature labor, she gave birth to a healthy baby. The mother remained in the same neurological state.
A person in this neurological state can survive for decades, but most people will only survive for a few years. As a family member, you may have to make many important decisions about their care, such as:
- finding the appropriate nursing home or facility
- attending to the financial aspects of long-term care
- making life-support decisions involving ventilators, feeding tubes, and other measures used to keep a person alive
- choosing whether to sign a do not resuscitate (DNR) so no lifesaving measures will be taken if the person stops breathing
These are complex decisions that should involve in-depth discussion with the doctors involved.
If the person has no living will or medical power of attorney, it may be helpful to consult with an attorney about your rights and responsibilities.
People in an unaware and unresponsive state can transition to a minimally conscious state.
Some will gradually regain consciousness. Some will go on to lose all brain function. There’s no way to accurately predict who will recover. Recovery depends on:
- the type and severity of the injury
- the person’s age
- how long the person was in the state
When an unaware and unresponsive neurological state lasts more than 4 weeks, it’s called a persistent vegetative state (PVS).
Among people with TBI who remain in an unaware and unresponsive neurological state for a month, about 50 percent regain consciousness. Some may be left with chronic disabilities. Recovery may be more difficult for people who experienced illness or nontraumatic brain injury.
It’s considered PVS if it was either:
- caused by nontraumatic brain injury and has lasted longer than 6 months
- due to TBI and has lasted longer than 12 months
Recovery can still happen, but it’s highly unlikely. Those who do regain consciousness after an extended period may be left with severe disabilities due to brain damage.
The first signs of recovery might be following a simple direction, like “Squeeze my hand.” The person might try to communicate by nodding, reaching for something, or gesturing.
They might be in a minimally conscious state at first, so progress can stall and gradually improve again.
Recovery varies from person to person. After thorough evaluation, the doctor can provide more information about their general outlook and what you can do to help.
An unaware and unresponsive neurological state isn’t the same thing as being brain-dead.
Your brain stem still functions, and you move through a sleep-wake cycle. But you’re unaware of and can’t interact with your surroundings. This neurological state typically follows a coma.
Treatment mainly involves supportive care. Recovery largely depends on the extent of injury to the brain. Each case is unique.
The attending physician can help you understand more and what you can expect.