Abstract
Despite recent advances in our understanding of consciousness disorders, accurate diagnosis of severely brain-damaged patients is still a major clinical challenge. We here present the case of a patient who was considered in an unresponsive wakefulness syndrome/vegetative state for 20 years. Repeated standardized behavioral examinations combined to neuroimaging assessments allowed us to show that this patient was in fact fully conscious and was able to functionally communicate. We thus revised the diagnosis into an incomplete locked-in syndrome, notably because the main brain lesion was located in the brainstem. Clinical examinations of severe brain injured patients suffering from serious motor impairment should systematically include repeated standardized behavioral assessments and, when possible, neuroimaging evaluations encompassing magnetic resonance imaging and 18F-fluorodeoxyglucose positron emission tomography.
Highlights
We here present the case of a 41-year-old man who was considered in an unresponsive wakefulness syndrome (UWS; previously referred to as “vegetative state”) for 20 years
We recently reported that a minimum of five CRS-R assessments conducted within a short time interval (e.g., 2 weeks) was necessary to reduce misdiagnosis [6]
If misdiagnosis of UWS is frequent for patients who are in a minimally conscious state, this misdiagnosis is, even if less frequent, still observed in patients who are totally conscious like LIS patients
Summary
We here present the case of a 41-year-old man who was considered in an unresponsive wakefulness syndrome (UWS; previously referred to as “vegetative state”) for 20 years. No stimulation or rehabilitation treatment was reported by the medical team in the nursing home Twenty years after his brain injury, the patient was transferred to our neurology department for a diagnostic evaluation as requested by the general practitioner of his nursing care home. The patient showed visual pursuits (on vertical and horizontal planes on all assessments), automatic motor responses (e.g., touch his mouth), anticipation and grimaces after nociceptive stimulations, and objects localization. When assessing his spatio-temporal orientation using YES/NO cards, the patient was able to correctly indicate his first and last name, the names of his roommate and the mother’s roommate.
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