Man Awakes After 19 Years in Minimally Conscious State

In a case called one-in-300 million, a 39-year-old man regained awareness three years ago and said "Mom,” following 19 years in a minimally conscious state.

The condition had been caused by an accident that resulted in severe closed-head trauma as well as axonal shearing. Although the patient is not yet able to walk, he can speak briefly and has regained some control over the movement in his legs. The case suggests that the nervous system has more ability to repair itself following traumatic injuries than was thought.

Investigators at Weill Cornell Medical College (New York, NY, USA) used diffusion-tensor magnetic resonance imaging (MRI) and positron emission tomography (PET) to track the changes in white matter in the patient's brain. They found evidence that suggested the growth of myelinated nerve fibers and rewiring in the posterior medial cortices. They also found large, bilateral regions of posterior white matter with significantly increased anisotropy in an early study but this changed to reduced anisotropy 18 months later.

Recovery from a minimally conscious state is very rare, noted study co-author Nicholas D. Schiff, M.D., of Weill Cornell Medical College.

"Severe brain damage represents an immense medical, social, and economic problem that warrants further research,” wrote the editorialists in the July 2006 issue of the Journal of Clinical Investigation. "Chronically unconscious or minimally conscious patients present unique problems for diagnosis, prognosis, treatment, and everyday management. They are vulnerable to being denied potentially life-saving therapy if clinical research remains solely focused on the acute stage of the disease. Current functional neuroimaging techniques can prospectively quantify residual neuronal plasticity and the challenging process of recovery.”



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