Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain.
BMC Neurol. 2010 Sep 3;10:77. doi: 10.1186/1471-2377-10-77.
The rate of recovery from the vegetative state (VS) is low. Currently, little is known of the mechanisms and cerebral changes that accompany those relatively rare cases of good recovery. Here, we combined functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) to study the evolution of one VS patient at one month post-ictus and again twelve months later when he had recovered consciousness.
fMRI was used to investigate cortical responses to passive language stimulation as well as task-induced deactivations related to the default-mode network. DTI was used to assess the integrity of the global white matter and the arcuate fasciculus. We also performed a neuropsychological assessment at the time of the second MRI examination in order to characterize the profile of cognitive deficits.
fMRI analysis revealed anatomically appropriate activation to speech in both the first and the second scans but a reduced pattern of task-induced deactivations in the first scan. In the second scan, following the recovery of consciousness, this pattern became more similar to that classically described for the default-mode network. DTI analysis revealed relative preservation of the arcuate fasciculus and of the global normal-appearing white matter at both time points. The neuropsychological assessment revealed recovery of receptive linguistic functioning by 12-months post-ictus.
These results suggest that the combination of different structural and functional imaging modalities may provide a powerful means for assessing the mechanisms involved in the recovery from the VS.
从植物状态（VS）中恢复的速度很慢。目前，对于那些极少数恢复良好的病例，伴随的机制和大脑变化知之甚少。在这里，我们结合功能磁共振成像（fMRI）和弥散张量成像（DTI）来研究一名 VS 患者在发病后一个月和 12 个月后恢复意识时的演变。
使用 fMRI 研究被动语言刺激的皮质反应以及与默认模式网络相关的任务诱导去激活。使用 DTI 评估整个白质和弓状束的完整性。我们还在第二次 MRI 检查时进行了神经心理学评估，以描述认知缺陷的特征。
fMRI 分析显示，在第一次和第二次扫描中，语言的激活具有解剖学上的适当性，但在第一次扫描中，任务诱导去激活的模式减少。在第二次扫描中，意识恢复后，这种模式变得更类似于经典的默认模式网络描述。DTI 分析显示，在两个时间点，弓状束和整个正常表现的白质都相对保留。神经心理学评估显示，在发病后 12 个月，接受性语言功能恢复。
这些结果表明，不同的结构和功能成像方式的结合可能为评估从 VS 中恢复的机制提供有力的手段。
