Friso’s Death: How Brain Injury Affects Patients

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Dutch Prince Johan Friso’s death did not come as a surprise for many who have expected it for some time.

Prince Friso at the PICNIC 2010
Photo by Maurice Mikkers ( PICNIC Network

Friso died 18 months after a skiing accident in 2012. Rescuers found him buried under an avalanche 15 minutes later. According to reports, he suffered from a “massive” brain damage and a heart attack for some 50 minutes. They performed cardiopulmonary resuscitation and brought him to London for treatment in a specialist neurological unit at the Wellington Hospital. The traumatic accident left him in coma.

He was eventually discharged in July 2013 but remained in a "state of minimal consciousness."

What happened to the well-loved prince has lead many to ask: What does state of minimal consciousness mean and what happens to patients with brain injury?

When a person suffers from brain injury, there is a change in consciousness or awareness of the self and the environment (ranging from mild to severe). In Friso’s case, he supposedly had a “massive” brain injury, which means he had serious injuries. As a result, there was a significant disturbance in his consciousness. 20-40% of persons with severe injuries may stay alive. Some, including Friso, are able to survive for a period of time and regain “minimal consciousness.”

For about a year and a half, Friso’s condition was reportedly in a state of minimal consciousness.

Brain Injury and Minimally Conscious State (MCS)

Patients with brain injury shift during the period of unconsciousness and next stages of recovery at a slower or faster rate. These changes mainly depend on the severity of injury.

Persons with minimal injuries may transition through these stages faster and some of the stages may not show or not even take place. Those with more severe injuries, however, may stop at one or a new stage and not recover further.

For those with longer periods of unconsciousness, improvement may be slower. Coma seldom lasts over a month. Some shift from coma to the vegetative state while others will possibly go from coma to a period of partial consciousness. Moving straight away from a state of coma or vegetative state to full consciousness is uncommon.

Those who have shorter periods of unconsciousness probably had less severe brain injuries at first. As a result, they are likely to improve better than those who had remained unconsciousness for an extended period.

Traumatic brain injury signifies a brain damage due to external forces like falls or vehicular collisions. Friso was struck and trapped by an avalanche, which lead to a lack of oxygen supply in his brain.

A month after a traumatic brain injury, around half of patients in a vegetative state (a clinical condition of unawareness of self and environment) slowly regain consciousness.

Some patients in an extended vegetative state may have longer recoveries but due to frequent complications like infections, pneumonia, and respiratory failure, they may not be able to survive.

Meanwhile, those who have a slow recovery of consciousness have persistent, decreased level of self and environmental awareness. Their level of communication and responses are inconsistent and restricted. This condition of limited awareness is called the minimally conscious state.

A minimally conscious state is usually characterized by a more uninterrupted improvement and notably more positive outcomes after injury, compared to a vegetative state. Patients are able to keep part of their conscious awareness (unlike those in a vegetative state). They may sometimes follow simple instructions, speak simple words or phrases, say yes or no or gesture, cry, smile, laugh, make sounds, reach or try to grasp items, look at people, and respond to people or things. But they do these things inconsistently.

Therefore, it is hard to differentiate the vegetative state from the minimally conscious state. Those in a minimally conscious state need similar extensive care given to those in a vegetative state.

Such condition can gradually improve or progressively worsen (especially with accompanying complications). Prince Frisco's health, unfortunately, deteriorated in time.

Source: MSKTC