After a major brain injury the diagnosis of a persistent coma or vegetative state has important short-term and long-term implications. Persistent vegetative state is considered permanent 1 year after traumatic brain injury and 3 months after nontraumatic coma. The early diagnosis of persistent vegetative state is discussed in this chapter. Disorders of prolonged unconsciousness have been redefined by functional MRI, but functional MRI has not found a clinical application. Functional MRI is not able to better predict outcome or awakening with sufficient certainty. Long-term care of debilitated neurological patients requires placement of a tracheostomy and gastrostomy.