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60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Magnetic resonance findings in vegetative state after severe head injury

Meeting Abstract

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  • B. Stiller - Klinik für Neurochirurgie, Otto-von-Guericke-Universität Magdeburg
  • M. Skalej - Institut für Neuroradiologie, Otto-von-Guericke-Universität Magdeburg
  • R. Firsching - Klinik für Neurochirurgie, Otto-von-Guericke-Universität Magdeburg

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocP01-06

doi: 10.3205/09dgnc254, urn:nbn:de:0183-09dgnc2542

Published: May 20, 2009

© 2009 Stiller et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: The cause of vegetative state has been controversial until today. Some patients in persistent vegetative state have attained much public and legal attention, but its cause remains unknown. Over decades, histological data has suggested lesions of the thalamus. As yet there are no reports on early magnetic resonance imaging (MRI) findings in vegetative state.

Methods: 220 patients in coma for a minimum of 24 hours after head injury were included in this prospective study. MRI was obtained within 8 days of the head injury in a 1.5 Tesla scanner using T1, T2, and FLAIR sequences. Lesion locations of all patients in a vegetative state after discharge were analyzed. The patients were followed for at last 3 years, the outcome was classified according to the Glasgow outcome scale (dead, persistently vegetative, severely and moderately disabled, lightly disabled).

Results: 47 out of 220 patients had bilateral lesions of the mesencephalon. 31 patients were discharged in a vegetative state, of which 19 patients remained persistently vegetative for six months or longer, and 12 patients for one year or longer, which means 25% of the patients. Without exception, in any of these patients bilateral lesions within the mesencephalon were identified. No other location was consistently found by MRI in these patients. Altogether, 45 out of 200 patients exhibited bilateral lesions of the mesencephalon. Thus, almost half of these patients exhibited a vegetative state.

Conclusions: Early MRI gave evidence that a vegetative state after head injury was only observed with bilateral lesion of the mesencephalon. Early MRI within a week of the injury can depict lesions which may be missed on late MRI several months later. As yet, MRI cannot predict the duration of the vegetative state. Of all patients with bilateral lesions of the mesencephalon, approximately 25% exhibit a vegetative state with a minimum duration of 1 year. Of all possible locations of lesions as indicated by MRI, bilateral lesion of the mesencephalon is consistently related with vegetative state.