PVS

Dear Mark,

Having finally and belatedly had a look at the Schiavo autopsy report, I should do you the courtesy of passing on my view that the press (and you following them) seems to have overinterpreted it grossly. What it actually says is exactly what was said by the doctors consulted before the event - you can't prove PVS on autopsy.

"5. Was Ms Schiavo in a ... PVS..?

PVS is a clinical diagnosis arrived at through physical examination of living patients. Postmortem correlations to PVS with reported pathological findings have been reported in the literature, but the findings vary with the etiology of the adverse neurological event."

More specifically, Throgmartin (lovely name - right up there with Throttlebottom) points out in the body that while there are pathology reports on people who have been diagnosed as being in PVS "there are no similarly published neuropathologic findings specific to the minimally conscious state' - and that pathology therefore can say at a pinch that a presentation is consistent with PVS but can't at all say that it's not also compatible with MCS (and, a fortiori, locked-in syndrome or recovered-from-PVS state).

He's specifically saying that he can't make a judgement on whether TS was conscious. Massive cerebral atrophy, yes; brain weight small (though bear in mind that that's after two week's dehydration) yes; but that doesn't determine consciousness. To say, as a number of commentators did, that she could never recover is either trivially true or deeply ambiguous, depending on where one's meaning lies on the continuum from 'recover consciousness', to 'recover to the status quo ante'.

Throgmartin does say that occipital lobe damage indicates cortical blindness, and to cover that in any detail I'd have to do rather more lit searching. On the basis of a quick run through medline I'm not absolutely positive that CB can be diagnosed on autopsy with absolute confidence, but I won't die in the last ditch on that one.

Anyway, I wouldn't like you to think that silence meant I'd slunk away.

`