Schiavo Autopsy Will Not Confirm Diagnosis

Neurologists say the autopsy that is planned to be performed on Terri Schiavo will not definitively confirm a diagnosis of persistent vegetative state.

"Persistent vegetative state or minimally conscious state is a clinical diagnosis," says Michael De Georgia, MD, head of the neurology/neurosurgery intensive care unit at the Cleveland Clinic Foundation. "It cannot be confirmed by autopsy."

Patients in a persistent vegetative state are a subgroup who suffer severe anoxic brain injury and progress to a state of wakefulness without awareness.

"The [pathologic examination of the] brain can't tell if there is a persistent vegetative state or not," says Harvard neuropathologist E. Tessa Hedley Whyte, MD. "The autopsy will show damage -- probably mostly scarring now -- and that damage will most likely correspond to some extent to what was seen on images."

According to court records, CT scans performed in 1996 and 2002 revealed "diffuse encephalomalacia and infarction consistent with anoxia, hydrocephalus ex vacuo, neural stimulator present."

Dr. De Georgia says that the extent of brain damage, confirmed on autopsy, "does reflect the absence of viable brain cells and the fewer brains cells a patient has the less likely it is that the patient will be conscious. But there is no standard cutoff that says if you lose this many brain cells you are in a persistent vegetative state."

Michael Williams, MD, an associate professor at Johns Hopkins in Baltimore, puts it this way. "If you only had the brain to look at and you didn't know anything about the history of the patient, pathology alone cannot prove or disprove a diagnosis of persistent vegetative state."

Dr. Williams says it is likely that autopsy will show "widespread damage to the cortex -- a condition called laminar necrosis -- and it is likely that there will also be significant damage to the thalamus."

While Dr. Williams says the autopsy can't confirm the diagnosis of persistent vegetative state, he says that receiving an autopsy report sometimes helps a family that is struggling to accept the diagnosis. "Sometimes additional evidence from a CT scan or an autopsy report -- something concrete -- helps bring some final understanding or acceptance," he says.