J Neurocrit Care.  2019 Jun;12(1):37-45. 10.18700/jnc.190080.

Clinical and neuroimaging determinants of minimally conscious and persistent vegetative states after acute stroke

Affiliations
  • 1Department of Neurology, Ege University Medical School Hospital, Izmir, Turkey. emre.kumral@ege.edu.tr

Abstract

BACKGROUND
Patients with persistent vegetative state (PVS) show no evidence of awareness of self or their environment, and those with minimally conscious state (MCS) have severely impaired consciousness with minimal but definite behavioral evidence of self or environmental awareness after stroke. Neuroimaging and clinical characteristics separating these two close consciousness states after stroke were insufficiently studied.
METHODS
We conducted a hospital-based cohort study of all patients with stroke (2011 to 2017) who underwent 3T magnetic resonance imaging and consciousness assessment after 3 months of inclusion. Univariate and multivariate regression analyses were used to estimate the relative risk of neuroimaging markers for differentiation of PVS and MCS.
RESULTS
Of 3,600 eligible subjects, 323 patients (0.09%) had PVS and 93 (0.02%) had MCS (mean age, 62.25±13.4 years). Higher stroke volume was strongly associated with PVS compared to MCS (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.98 to 1.00; P=0.001). On univariate analysis, cingulate gyrus (OR, 2.7; 95% CI, 1.62 to 4.36; P=0.001) and corpus callosum (OR, 2.1; 95% CI, 1.28 to 3.44; P=0.003) involvement was significantly associated with PVS. However, on multivariate analysis, only cingulate gyrus involvement was independently associated with PVS (OR, 2.2; 95% CI, 1.33 to 3.72; P=0.002).
CONCLUSION
Our results indicate that PVS and MCS are different consciousness states according to clinical and neuroimaging findings. To predict outcome, cognitive performance of these patients should be well questioned after stroke.

Keyword

Minimally conscious state; Persistent vegetative state; Ischemic stroke; Hemorrhagic stroke; Cognition disorders; Outcome

MeSH Terms

Cognition Disorders
Cohort Studies
Consciousness
Corpus Callosum
Gyrus Cinguli
Humans
Magnetic Resonance Imaging
Multivariate Analysis
Neuroimaging*
Persistent Vegetative State*
Stroke Volume
Stroke*
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