Neocortical death in infants: behavioral, neurologic, and electroencephalographic characteristics

Neocortical death is a form of the persistent vegetative state characterized by the maintenance of sleep/wakeful cycles and spontaneous respirations and the lack of cognitive function. It is difficult to diagnose in neonates and young infants because their cognitive skills are limited by inexperience and by immaturity of the central nervous system. Because neocortical death has not been described previously for this age group, we report the neurologic, behavioral, electroencephalographic, and computed tomographic characteristics of three infants who survived in the persistent vegetative state following severe brain injury. Each infant appeared to exhibit some complex behaviors, including interaction with the environment and the examiners, although the electroencephalograms documented no electrical activity of cerebral origin. Computed tomography revealed extensive destruction of the cerebral hemispheres. Infants and newborns with a history suggesting brain injury and with the neurologic and behavioral characteristics described here should be evaluated with serial electroencephalograms and computed tomography to diagnose the syndrome of neocortical death.