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Awakenings from persistent vegetative state: report of three cases with parkinsonism and brain stem lesions on MRI
  1. W Matsuda1,
  2. A Matsumura2,
  3. Y Komatsu1,
  4. K Yanaka2,
  5. T Nose2
  1. 1Department of Neurosurgery, Tsukuba Medical Centre Hospital, Ibaraki, Japan
  2. 2Department of Neurosurgery, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan
  1. Correspondence to:
 Dr Wakoto Matsuda, Department of Neurosurgery, Tsukuba Medical Centre Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki 305-0005, Japan;


Three patients with a persistent vegetative state after severe head injury are reported. They recovered from a prolonged disturbance of consciousness after the administration of levodopa. These patients all had parkinsonian features. On magnetic resonance imaging, the distribution of lesions implied a diffuse axonal injury involving the substantia nigra or ventral tegmental area. The existence of patients whose dopaminergic systems may have been selectively damaged by a severe head injury should be recognised because such individuals may respond to levodopa treatment.

  • diffuse axonal injury
  • persistent vegetative state
  • parkinsonism
  • levodopa

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  • Competing interests: none declared