Neuropathological findings in the brain of Karen Ann Quinlan. The role of the thalamus in the persistent vegetative state.

@article{Kinney1994NeuropathologicalFI,
  title={Neuropathological findings in the brain of Karen Ann Quinlan. The role of the thalamus in the persistent vegetative state.},
  author={Hannah C. Kinney and Julius Korein and Ashok Panigrahy and Pieter Dikkes and Robert Goode},
  journal={The New England journal of medicine},
  year={1994},
  volume={330 21},
  pages={
          1469-75
        }
}
BACKGROUND Karen Ann Quinlan had a cardiopulmonary arrest in 1975 and died 10 years later, having never regained consciousness. Her story prompted a national debate about the appropriateness of life-sustaining treatment in patients who are in a persistent vegetative state and led to the development of medicolegal guidelines for the care of such patients. This report describes the neuropathologic features of Quinlan's brain. METHODS The entire brain and spinal cord were systematically sampled… 
The neuropathology of the vegetative state after an acute brain insult.
TLDR
A detailed neuropathological study of the brains of 49 patients who remained vegetative until death, 1 month to 8 years after an acute brain insult, finds profound damage to the subcortical white matter or to the major relay nuclei of the thalamus renders any structurally intact cortex unable to function.
Residual cerebral activity and behavioural fragments can remain in the persistently vegetative brain.
TLDR
The variations in cerebral metabolism in chronic PVS patients indicate that some cerebral regions can retain partial function in catastrophically injured brains.
Novel aspects of the neuropathology of the vegetative state after blunt head injury.
TLDR
Evidence is provided for the importance of diffuse brain damage to white matter as the structural basis of the vegetative state after blunt head injury with contributions from neuronal loss in the thalami and the hippocampus.
The persistent vegetative state after closed head injury: clinical and magnetic resonance imaging findings in 42 patients.
TLDR
The data indicate that diffuse axonal injury may be the major form of primary brain damage in the posttraumatic persistent vegetative state and MR imaging, in conjunction with a precise clinical correlation, may provide useful supportive information for the accurate diagnosis of a persistent vegetatives state after traumatic brain injury.
Bilateral thalamic damage, cortical hypometabolism and behavioural disturbances
TLDR
The absence of primary lesions of cortical regions on CT scan and MRI and the neuroanatomical considerations on the diffuse projections running from medial nuclei and pulvinar to large parts of anterior neocortex supported the hypothesis that thalamic damage could be responsible for reduced metabolism in anterior cortical areas.
[Thalamic metabolism and neurological outcome after traumatic brain injury. A voxel-based morphometric FDG-PET study].
TLDR
The results confirm the vulnerability of the thalamus to suffering the effects of the acceleration-deceleration forces generated during a TBI and suggest patients with low thalamic metabolism represent a subset of subjects highly vulnerable to neurological and functional disability after TBI.
Thalamic Damage in Periventricular Leukomalacia: Novel Pathologic Observations Relevant to Cognitive Deficits in Survivors of Prematurity
TLDR
The prevention of thalamic damage may be required for the eradication of defects in survivors with PVL, and substantial involvement of the mediodorsal, and reticular nuclei in PVL is tested.
Disconnection of the ascending arousal system in traumatic coma.
TLDR
It is proposed that traumatic coma may be a subcortical disconnection syndrome related to the disconnection of specific brainstem arousal nuclei from the thalamus and basal forebrain.
Aetiological differences in neuroanatomy of the vegetative state: insights from diffusion tensor imaging and functional implications
Background An improved in vivo understanding of variations in neuropathology in the vegetative state (VS) may aid diagnosis, improve prognostication and help refine the selection of patients for
Perception of pain in the persistent vegetative state?
  • M. Klein
  • Psychology, Medicine
    European journal of pain
  • 1997
TLDR
Questions are cast on the assumption that nociceptive responses, such as flexor or extensor spasms or withdrawal of extremities in response to pinprick, would not necessarily reflect the perception of pain.
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