Persistent Vegetation Means Unconsciousness? How to Manage Vegetation and Memory Disturbances Following Severe Brain Damage

There has been no answer forthcoming about how to manage the vegetative state and memory disturbances that follow severe brain damage, the main reasons for which are the difficult apprehension of persistent vegetation by previous concepts of unconsciousness and the meager understanding of mechanisms concerning a worsening of vegetation, memory disturbances, and emotional retardation. For a long time, we have diagnosed consciousness with responsiveness by outer stimulation. However, the human consciousness is not so simple. The author has introduced a two-type consciousness theory; the first consists in responsive consciousness to outer stimulation (outer consciousness) and the second, consciousness without the need of outer stimulation (inner consciousness) comprising, e.g., emotion, feeling of love, memory, consideration, anger, and spirit and volition. The mechanism of a degradation in persistent vegetation is selective radical damage of the center of inner consciousness, the dopamine A10 central nervous system, that includes the amygdala and caudate nucleus (emotion), the nucleus accumbens (feeling of love), the hippocampus (memory), the frontal association cortex (consideration), the nucleus of the amygdala (emotional spirit), and the hypothalamus (volition), by dopamine release from these nuclei. The dopamine released extracellularly from the injured dopamine nervous system reacts with oxygen to produce hydrogen peroxide and quinine. The hydrogen peroxide changes to neurotoxic OH radicals. The dopamine released from injured neurons causes selective radical damage of the dopamine nervous system within the central nervous system. The early induction of brain hypothermia at 32°–34°C is very successful for the prevention of NO radical reactions in the dopamine nervous system. The high incidence of simultaneous localized low density of the nucleus of the amygdala (77%) and the hippocampus (88%) in persistent vegetation indirectly supports the new concept of the two-consciousness theory and mechanism of deterioration of the vegetative state. The scoring of persistent vegetation and five useful criteria, namely, response of emotional muscle around the mouth and eyes by touching, increasing the cerebrospinal fluid (CSF) dopamine/prolactin ratio by treatment, absence of severe localized low density of the hippocampus and amygdala nucleus on computed tomography, presence of CSF epinephrine, and responsiveness of sensory evoked potential N20 are very useful in devising a strategy of brain hypothermia treatment.