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I'm writing a story, in which it's in a character's best interest to fake a brain-damaged state -- just for a week or two. I know MRI's are available to access brain activity, but would my character be able to pull off the vegetative act, given modern tech?

Edit: The character is in a situation where brain damage wouldn't come as a surprise...therefore, there'd be no rigorous tests of brain health. I'm mainly wondering if normal brain health would be obvious through routine care in a modern hospital setting.

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    $\begingroup$ Hi, which do you want a vegetative state or brain damage? They're not the same thing. A veg state can be caused by brain damage though. $\endgroup$ – A new normal. Sep 14 '19 at 12:40
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    $\begingroup$ Is your character an advanced practitioner of Laya Yoga by any chance? $\endgroup$ – AlexP Sep 14 '19 at 12:52
  • $\begingroup$ @Chickensarenotcows, I guess I could go with "brain damaged." Mainly just wondering if good acting is all that's necessary, or if it's impossible to fool an MRI or any other tests a layman like me isn't aware of. $\endgroup$ – cal Sep 14 '19 at 13:08
  • $\begingroup$ @AlexP Sorry, no Laya Yoga. $\endgroup$ – cal Sep 14 '19 at 13:09
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First your premise that they won't "by trying too hard to detect a fake":

As some one who has had a lot of CTs and MRIs: they may not find minute damage (esp. to axions) in patients who have brain injuries. However, they will do a CT & MRI right away and probably several different ones. This is because they will need to rule out bleeding in the brain and other life-threatening conditions as 20 to 40% of patients with this acute an injury dies.

Basically, they are going to look hard at the brain of someone unconscious for a few hours let alone days because this would indicate a severe case of TBI.

Now back to the, can you fake TBI for a little while:

To quote the American Society on Neuroradiology on Traumatic Brain Injuries (emphasis mine):

Magnetic resonance imaging (MRI) is a powerful diagnostic tool that can detect signs of injury such as minute bleeding (microhemorrhage), small areas of bruising (contusion) or scarring (gliosis), which are invisible to the CT scan. Newer, specialized types of MRI can assess brain structure at an even finer level or measure brain function to detect alterations in brain structure and function due to TBI. Because microscopic injury to the brain may be a cause of problems, however, even MRI may not be able to detect any abnormality in a patient with TBI.

So can someone fake brain damage? Possibly (may even just get misdiagnosed in a situation like you give where "brain damage is expected"). However, in your case, this would not be a mild form of TBI (unconscious for weeks = acute) so the lack of this evidence in an MRI would probably start doctors looking at other things (with "cures" which will cause bad things to happen to your character due to side-effects or just not having the condition).

Can you fake it for weeks in a vegetative state?

Again, its your story, so doctors could miss all the signs and a vegetative state is not a coma so you can respond to stimuli. So its possible for at least a bit.

However, the difference in reaction from a person with TBI and a "normal" individual can be striking and a good ER will be used to seeing these differences. For instance, even if you take medication which makes your person not react to smell in any fashion because he is faking the reaction people with TBI may have (when injuries include the nerves from brain to nose being cut so don't have a sense of smell anymore1) its may be hard to fake these within an MRI when their testing your reaction (the sound and lights of the MRI themselves can immediately show different reactions then expected within a person with TBI's brain 1).

To further point out how hard it is to fake TBI for a long period (for your story but also because I don't want people to think there isn't ways to detect it), see the rest of my earlier quoted statement:

Long after the injury, MRI as well as CT may demonstrate brain atrophy, which results when dead or injured brain tissue is reabsorbed following TBI. Because injured brain tissue may not completely recover following TBI, changes due to TBI may be detectable many years after an injury.

TLDR;

So there's going to be a point where the doctors say "this isn't caused by brain injury. What are our other options?". I would put that point at 2 days over 2 weeks but it is possible that a misdiagnosis or other story reason extends this and when coming out of the state the doctors just say "well, we'll have to follow up and see if we see the other indicators as he is doing better now". Probable? no. Possible? there's a lot of malpractice cases for a reason.

1: personal experience

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  • $\begingroup$ @linkBThanks for the thorough and answer. $\endgroup$ – cal Sep 17 '19 at 15:50
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Falling down a K hole.

It is hard to keep from responding to the world - especially if someone hurts you to see if you are faking. But it is a lot easier with drugs. Ketamine is used to achieve this state.

https://www.verywellmind.com/what-is-a-k-hole-21861

Ketamine is a dissociative drug. In simple terms, dissociative drugs make users feel detached from their surroundings as if they are not really there. This feeling of dissociation becomes more intense with higher dosages, which make users feel very disconnected from, and unaware of, their surroundings—even when they may technically be awake. They may also feel disconnected from, or unable to control, their own bodies, including the ability to speak and move around easily.

One way to think about this is that the k hole is a state between intoxication and a coma. While the consciousness of the real world diminishes in a k hole, a fantasy world of delusions and hallucinations can take over. This is usually temporary, although longer-term users may begin to show ongoing dissociative and psychotic symptoms...

The dissociative state can be very useful as a type of anaesthesia. Ketamine has been used for decades for minor procedures like dental work on developmentally disabled persons. It does not carry with it the risk of respiratory depression. The person on ketamine is mentally in a place where what is going on in the world does not matter and so does not struggle or resist.

This would be interesting to write also. Your character could be trying to pay attention to the world, but is slipping in and out of strange fantasies and hallucinations. These might come back later in the story.

Note: there does not to my knowledge exist a sustained release form of ketamine, like a pill or a patch. As far as I know it is all IV. Your character would need some way of staying continuously on ketamine without his care team realizing it. Maybe he could hack an insulin pump to deliver ketamine and have it placed inside his body where it would not be found?

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  • $\begingroup$ Very interesting, thanks. My character would be expected to be in a brain-damaged state...at least, it wouldn't come as a surprise. So probably nobody would be trying too hard to detect a fake. My main question is...would it be noticeable under normal circumstances (like, "Hey, Glenda's showing normal brain patterns today during my normal brain pattern check..." or something like that? $\endgroup$ – cal Sep 15 '19 at 0:52
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If the question is "Would MRI scans reveal that this person is in fact NOT brain damaged"? Pretty much, yes.

The main thing that would be a giveaway is the brains response (as in brain activity) in certain parts ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1647299/ ) to hearing, pain, etc. There is no way (at least that I've found) to ignore this to fake brain damage, at least not without drugging yourself, which is dangerous.

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  • $\begingroup$ Hmm, thanks. I've heard of situations where a person could be mentally present, but physically paralyzed (trapped inside your body, basically). Could scans from a person faking brain damage be interpreted as something like that? $\endgroup$ – cal Sep 16 '19 at 13:49
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    $\begingroup$ @cal Do you mean like in a state of coma or not in coma? I am not aware of such a state outside of being in a coma. In such cases the brain activity is minimal (brain wave in the Alpha range, but called Alpha-coma 8 -12Hz), but it does happen that more activity is observed when the person is called by name or touched. For reference, normal brain waves would be in the Beta range (12-38Hz) so it would be noticabble whether someone is faking a coma. $\endgroup$ – Joker21srb Sep 16 '19 at 15:33
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    $\begingroup$ Well, I just did some light research on "locked in syndrome." Here's just one article:medicinenet.com/locked-in_syndrome/… $\endgroup$ – cal Sep 16 '19 at 15:37
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    $\begingroup$ @cal I did not know of this (horrifying) syndrome. Thanks for this article. This syndrome seems like it could be faked (as the person is awake and aware) and not be given away by scans, if this is what you are looking for. If you are looking for brain damage that would affect a persons (for lack of a better term) reasoning, brain damage, in modern day, first/second world countries is diagnosed through brain scanning*. *Less severe cases can be diagnosed without (and sometimes skip) scanning. You could include some medical malpractice in the story that the character takes advantage of. :p $\endgroup$ – Joker21srb Sep 16 '19 at 16:00
  • $\begingroup$ Cool. I appreciate your time and suggestions! $\endgroup$ – cal Sep 16 '19 at 16:25

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