Brain Function and Structure Changes in the Prognosis Prediction of Prolonged Disorders of Consciousness.

IF 2.3 3区 医学 Q3 CLINICAL NEUROLOGY
Weiguan Chen, Ye Zhang, Aisong Guo, Xuejun Zhou, Weiqun Song
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引用次数: 0

Abstract

Objectives: To observe the functional differences in the key brain areas in patients with different levels of consciousness after severe brain injury, and provide reference for confirming the objective diagnosis indicators for prolonged disorders of consciousness (pDoCs).

Methods: This prospective study enrolled patients with pDoCs hospitalized in the department of rehabilitation medicine of our Hospital. Levels of consciousness and clinical outcomes were assessed according to diagnostic criteria and behavioral scales. Resting-state functional magnetic resonance imaging (rs-fMRI) and diffusion tensor imaging (DTI) of 30 patients with different levels of consciousness was performed. The patients were grouped as conscious or unconscious according to whether they regained consciousness during the 12-month follow-up.

Results: Thirty patients were enrolled, including eight with unresponsive wakefulness syndrome/vegetative state, eight with minimally conscious state, six with emergence from the minimally conscious state, and eight with a locked-in syndrome. There were 19 and 11 patients in the conscious and unconscious groups. Compared with the unconscious group, the left basal nucleus was activated in the conscious group, and there were significant differences in white matter fiber bundles. Correlations were observed between the regional homogeneity (ReHo) value of the cerebellum and the Glasgow coma scale score (r = 0.387, P = 0.038) and between the ReHo value of the left temporal and the coma recovery scale-revised score (r = 0.394, P = 0.035).

Conclusions: The left insula and cerebellum might be important for regaining consciousness. The brain function activity and structural remodeling of the key brain regions and the activation level of the cerebellum are correlated with clinical behaviors and have potential application value for the prognosis prediction of pDoCs patients.

脑功能和结构变化对长期意识障碍的预后预测。
目的观察重度颅脑损伤后不同意识障碍程度患者脑部关键区域的功能差异,为确诊意识障碍时间延长(pDoCs)的客观诊断指标提供参考:这项前瞻性研究的对象是在我院康复医学科住院治疗的意识障碍患者。根据诊断标准和行为量表对意识水平和临床结果进行评估。对30名不同意识水平的患者进行了静息态功能磁共振成像(rs-fMRI)和弥散张量成像(DTI)检查。根据患者在 12 个月的随访期间是否恢复意识,将其分为有意识和无意识两组:30例患者中,8例为无反应清醒综合征/植物状态,8例为微意识状态,6例为脱离微意识状态,8例为锁定综合征。有意识组和无意识组分别有 19 名和 11 名患者。与昏迷组相比,清醒组的左侧基底核被激活,白质纤维束也有显著差异。小脑的区域同质性(ReHo)值与格拉斯哥昏迷量表评分(r = 0.387,P = 0.038)、左颞的ReHo值与昏迷恢复量表修订版评分(r = 0.394,P = 0.035)之间存在相关性:结论:左侧岛叶和小脑可能是恢复意识的重要因素。关键脑区的脑功能活动和结构重塑以及小脑的活化水平与临床表现相关,对pDoCs患者的预后预测具有潜在的应用价值。
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来源期刊
Brain Topography
Brain Topography 医学-临床神经学
CiteScore
4.70
自引率
7.40%
发文量
41
审稿时长
3 months
期刊介绍: Brain Topography publishes clinical and basic research on cognitive neuroscience and functional neurophysiology using the full range of imaging techniques including EEG, MEG, fMRI, TMS, diffusion imaging, spectroscopy, intracranial recordings, lesion studies, and related methods. Submissions combining multiple techniques are particularly encouraged, as well as reports of new and innovative methodologies.
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