A 39-year-old woman was admitted to our clinic for the first time in a traumatic VS, whose duration at that time was 5 months. The cause of initial brain damage was severe TBI with skull fracture, DAI II with contusion in the polar parts of the left temporal and frontal lobes, and subarachnoid hemorrhage. Fractures of the ribs and left shank were detected in the acute period of trauma. In-life monitoring and treatment lasted for 13 months and included 2 hospitalizations at the clinic (lasting 1 month each), with an interval of 7 months between them. During both hospitalizations to treat spasticity, botulinum toxin (BT) A (incobotulinumtoxinA; Merz Pharma GmbH & Co. KGaA, Frankfurt, Germany) was injected into all spastic muscles; the total dose was 800 U (20 U/kg of body mass) at the first hospitalization and 300 U at the second. In addition, after the first hospitalization, the patient began to receive an N-methyl-d-aspartate receptor (NMDA) receptor antagonist (memantine) and a carbonic anhydrase inhibitor (acetazolamide). Because of repeated infection (pneumonia), the patient received courses of antibacterial therapy 3 times. At both hospitalizations, clinical neurologic examinations (the level of consciousness was assessed with the Coma Recovery Scale-Revised [CRS-R], and assessment of muscle tone was performed according to the modified Ashworth Scale [MAS]) and PET were performed prior to and 3 weeks after treatment. All examinations (including electroencephalography [EEG], MRI and PET) and treatments were conducted according to the medical board's decisions and the protocol approved by the Institutional Academic Council of the N.P. Bechtereva Institute of the Human Brain of the Russian Academy of Sciences (IHB RAS) and the local ethical committee. Written informed consent was obtained from the patient's mother. When not hospitalized, the patient remained at home.
In the months after the second hospitalization, against a background of continuous positive dynamics, the patient (40 years old at that point) died due to sudden cardiac failure. Along with a standard autopsy, a neuropathologic brain analysis was also performed.