Persistent vegetative state : sever brain damage which doesn't involve the brain stem *Brainstem is intact with continuous circulation and respiration *These patients still: breathe spontaneously, open and close their eyes, swallow, have a preserved sleep wake cycle, make facial grimaces *They show no behavioral evidence of awareness (can't speak or obey commands) *You can observe in this figure differences in brain metabolism measured in brain death compared with healthy subjects, patients in brain death show an empty skull sign. In vegetative state, brain metabolism is massively decreased (to 40-50% of normal values) but not absent.