Arousal without awareness may follow TBI, hypoxia, carbon monoxide poisoning, and other global cerebral insults (see Chapter 11). After closed-head injury, recovery from a vegetative state is less likely in patients who suffer injuries to the corpus callosum and dorsolateral brain stem.91 F-fluorodeoxyglucose-PET studies point to altered connectivity of association cortices and hypometabolism in prefrontal, pre-motor, parietotemporal, and posterior cingu-late regions.92 Global metabolic rates are often 30%-50% of normal, but islands of relatively normal glucose metabolism associated with fragments of behavior have been identified.92a
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