We describe the clinical course of a 51-year-old woman in a vegetative state and of a 63-year-old woman in a minimally conscious state. The difference between these two states is an important one, as clinical course, prognosis and medical-ethical considerations of both are different. In practice it is difficult to distinguish between a vegetative state and a minimally conscious state, but the use of a Post-Acute Level of Consciousness scale helps to illustrate the differences. Expertise, research, and application of functional neuro-imaging techniques (PET, fMRI) might also be useful. The differences between these two states regarding rehabilitation, pain management and medical-ethical decisions are important. The effects of neuro-rehabilitation and the implications of a minimally conscious state for patients and their proxies need further investigation.

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