Hildebrandt Helmut, Happe Svenja, Deutschmann Angelika, Basar-Eroglu Canan, Eling Paul, Brunhöber Jens
Klinikum Bremen-Ost, Department of Neurology, Züricher Str. 40, 28325 Bremen, Germany; University of Oldenburg, Institute of Psychology, Germany.
J Neurol Sci. 2007 Sep 15;260(1-2):150-8. doi: 10.1016/j.jns.2007.04.035. Epub 2007 May 30.
Patients in a vegetative state (VS) show a spontaneous wake-sleep-cycle but no evidence of awareness, of interaction with the environment, voluntary action, and language comprehension. The neuropathological conditions underlying VS are still not fully understood. In this retrospective study we focused on VS due to hypoxia and used SPECT, VEP and event related potentials (N100, N200, MMN, and P300) to assess differences between a group of patients moving into a permanent VS (n=13) and a group recovering from VS (n=8). The two groups were matched for age, gender, duration of illness, and on the coma remission scale at admission. The patient groups differed in global uptake of (99m)Tc-ethylencysteine dimer (being reduced in non-recovered VS patients to 2/3 of the recovered group), and in presence of VEP and N100 (recovered patients always had a present VEP and N100). Moreover, analysis of uptake in specific brain areas showed that the recovered group had a higher perfusion in the visual cortex and in the precuneus, whereas no differences were found in the frontal pole and more ventral parts of the brain. Statistical testing revealed a strong association between occipital and parietal perfusion and the presence of a VEP, but no specific results for the N100. We conclude that occipital and parietal lobe perfusion and rudimentary vision may be critical characteristics distinguishing between VS and patients recovered from VS. Although this may just reflect haemodynamics during hypoxia leading to differences in severity of VS, it also may be regarded as a functional precondition for orientation towards stimuli and therefore for conscious actions in general.
处于植物人状态（VS）的患者呈现出自发的睡眠-觉醒周期，但没有意识、与环境互动、自主行动及语言理解的迹象。VS潜在的神经病理学状况仍未被完全理解。在这项回顾性研究中，我们聚焦于因缺氧导致的VS，并使用单光子发射计算机断层扫描（SPECT）、视觉诱发电位（VEP）和事件相关电位（N100、N200、失匹配负波（MMN）和P300）来评估一组进入永久性VS的患者（n = 13）和一组从VS恢复的患者（n = 8）之间的差异。两组在年龄、性别、病程以及入院时的昏迷缓解量表方面相匹配。患者组在（99m）锝-乙烯半胱氨酸二聚体的整体摄取方面存在差异（未恢复的VS患者摄取量降至恢复组的2/3），并且在VEP和N100的存在情况方面也有差异（恢复的患者VEP和N100总是存在）。此外，对特定脑区摄取情况的分析表明，恢复组在视觉皮层和楔前叶有更高的灌注，而在额极和大脑更靠腹侧的部分未发现差异。统计检验显示枕叶和顶叶灌注与VEP的存在之间存在强关联，但N100没有具体结果。我们得出结论，枕叶和顶叶灌注以及基本视觉可能是区分VS患者和从VS恢复的患者的关键特征。尽管这可能仅仅反映了缺氧期间的血流动力学情况，导致VS严重程度的差异，但它也可能被视为对刺激定向以及因此对一般有意识行动的功能前提条件。
