Di H B, Yu S M, Weng X C, Laureys S, Yu D, Li J Q, Qin P M, Zhu Y H, Zhang S Z, Chen Y Z
Zhejiang University School of Medicine, Hangzhou 310006, China.
Neurology. 2007 Mar 20;68(12):895-9. doi: 10.1212/01.wnl.0000258544.79024.d0.
A challenge in the management of severely brain-damaged patients with altered states of consciousness is the differential diagnosis between the vegetative state (VS) and the minimally conscious state (MCS), especially for the gray zone separating these clinical entities.
To evaluate the differences in brain activation in response to presentation of the patient's own name spoken by a familiar voice (SON-FV) in patients with VS and MCS.
By using fMRI, we prospectively studied residual cerebral activation to SON-FV in seven patients with VS and four with MCS. Behavioral evaluation was performed by means of standardized testing up to 3 months post-fMRI.
Two patients with VS failed to show any significant cerebral activation. Three patients with VS showed SON-FV induced activation within the primary auditory cortex. Finally, two patients with VS and all four patients with MCS not only showed activation in primary auditory cortex but also in hierarchically higher order associative temporal areas. These two patients with VS showing the most widespread activation subsequently showed clinical improvement to MCS observed 3 months after their fMRI scan.
The cerebral responses to patient's own name spoken by a familiar voice as measured by fMRI might be a useful tool to preclinically distinguish minimally conscious state-like cognitive processing in some patients behaviorally classified as vegetative.
对于意识状态改变的严重脑损伤患者的管理而言，一个挑战在于植物状态（VS）和微意识状态（MCS）之间的鉴别诊断，尤其是对于分隔这些临床实体的灰色地带。
评估VS和MCS患者在听到熟悉声音说出自己名字（SON-FV）时大脑激活的差异。
我们使用功能磁共振成像（fMRI）对7例VS患者和4例MCS患者听到SON-FV时的残余脑激活进行了前瞻性研究。在fMRI检查后长达3个月的时间里通过标准化测试进行行为评估。
2例VS患者未显示出任何显著的脑激活。3例VS患者在初级听觉皮层内显示出SON-FV诱导的激活。最后，2例VS患者和所有4例MCS患者不仅在初级听觉皮层有激活，而且在层级更高的联合颞叶区域也有激活。这2例显示出最广泛激活的VS患者随后在fMRI扫描3个月后临床症状改善为MCS。
通过fMRI测量的大脑对熟悉声音说出患者自己名字的反应可能是一种有用的工具，可在临床前区分一些行为上被归类为植物人的患者中类似微意识状态的认知加工。
