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Minimally Conscious State

By

Kenneth Maiese

, MD, National Heart, Lung, and Blood Institute

Last full review/revision Sep 2020| Content last modified Sep 2020
Click here for the Professional Version

A minimally conscious state is severe but not complete impairment of awareness. It results from widespread damage to the cerebrum (the part of the brain that controls thought and behavior).

  • A minimally conscious state may result from brain damage, or it may follow a vegetative state as people recover some function.

  • People in a minimally conscious state do some things that indicate some awareness of self and of their environment, such as making eye contact.

  • Doctors diagnose a minimally conscious state only after they observe people for a period of time and on more than one occasion and find some evidence of awareness in people whose consciousness is severely impaired.

  • People in a minimally conscious state require comprehensive care, including good nutrition and measures to prevent problems due to not being able to move (such as pressure sores).

Symptoms of Minimally Conscious State

People in a minimally conscious state, unlike those in a vegetative state, do some things that indicate some awareness of self and of their environment. They may do the following:

  • Make eye contact

  • Follow objects with their eyes

  • Reach for objects

  • Respond to questions (although often with the same word whether it is appropriate or not)

  • React to all commands in a usual but usually inappropriate way (for example, by blinking)

Diagnosis of Minimally Conscious State

  • A doctor's evaluation

  • Imaging tests such as magnetic resonance imaging

Doctors suspect minimally conscious state based on symptoms. But before a minimally conscious state can be diagnosed, people should be observed for a period of time and on more than one occasion.

An imaging test, such as magnetic resonance imaging (MRI) or computed tomography (CT), is done to check for disorders that may be causing the problem, especially those that can be treated.

Prognosis of Minimally Conscious State

Most people in a minimally conscious state tend to improve continuously, but improvement is limited. A few people regain the ability to communicate and understand, sometimes after many years. However, very few recover enough to live and function independently. The longer a minimally conscious state lasts, the less function people are likely to regain. However, with skilled nursing care, people can live for years. Recovery may be better when the cause is a head injury.

There have been reports of people awakening after spending years in what appears to be a coma. These reports often involve people who had been in a minimally conscious state after a head injury.

Treatment of Minimally Conscious State

  • Preventive measures for problems due to immobilization

  • Good nutrition

  • Possibly certain drugs

Long-term care

Providing good nutrition (nutritional support Overview of Nutritional Support Many undernourished (see Undernutrition) and critically ill people need additional nutrition (nutritional support). Artificial feeding, which uses commercial nutrient mixtures rather than food... read more ) is important. People are fed through a tube inserted through the nose and into the stomach (called tube feeding). Sometimes they are fed through a tube inserted directly into the stomach or small intestine through an incision in the abdomen. Drugs may also be given through these tubes.

Pressure sores can be prevented by frequently repositioning the person and placing protective padding under parts of the body that are in contact with the bed, such as the heels, to protect them.

To prevent contractures, physical therapists gently move the person’s joints in all directions (passive range-of-motion exercises) or splint joints in certain positions.

Preventing blood clots includes use of drugs and compression or elevation of the person's legs. Moving the limbs, as occurs in passive-range-of-motion exercises, may also help prevent blood clots.

If people are incontinent, care should be taken to keep the skin clean and dry. If the bladder is not functioning and urine is being retained, a tube (catheter) may be placed in the bladder to drain urine. Catheters are carefully cleaned and regularly examined to prevent urinary tract infections from developing.

Other treatments

A very few people have improved after certain drugs were prescribed, but only for as long as the drug was continued. These drugs include zolpidem (a sleep aid), apomorphine (used to treat Parkinson disease), and amantadine (used to treat viral infections). However, no treatment has been proved effective.

Music therapy may have some slight beneficial effects by stimulating some response in people in a minimally conscious state. But the usefulness of this therapy is as yet unclear.

NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
Click here for the Professional Version
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A brain abscess is a pocket of pus in the brain. Which of the following is NOT a common cause of a brain abscess?
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