Predicting the chances of recovery of consciousness and communication in patientswho survive their comabut transit in a vegetative state orminimally

Predicting the chances of recovery of consciousness and communication in patientswho survive their comabut transit in a vegetative state orminimally conscious state (MCS) remains a major challenge for their medical caregivers. Very few studies have examined the slow neuronal changes underlying functional recovery of consciousness from severe chronic brain damage. A case study in this issue of the JCI reports an extraordinary recovery of functional verbal communication andmotor function in a patientwho remained inMCS for 19 years (see the related article beginning on page 2005). Diffusion tensorMRI showed increased fractional anisotropy (assumed to reflect myelinated fiber density) in posteromedial cortices, encompassing cuneus and precuneus. These same areas showed increased glucose metabolism as studied by PET scanning, likely reflecting the neuronal regrowth paralleling the patient’s clinical recovery. This case shows that old dogmas need to be oppugned, as recovery withmeaningful reduction in disability continued in this case for nearly 2 decades after extremely severe traumatic brain injury.