Errante Antonino, Saviola Donatella, Fasano Fabrizio, Basagni Benedetta, Alinovi Serena, Bosetti Sara, Chiari Margherita, Minardi Rita, Pinardi Chiara, Crisi Girolamo, Fogassi Leonardo, De Tanti Antonio
Department of Medicine and Surgery, University of Parma, Parma, Italy.
Cardinal Ferrari Rehabilitation Centre, S. Stefano Institute, Fontanellato, Italy.
J Cent Nerv Syst Dis. 2019 Apr 18;11:1179573519843492. doi: 10.1177/1179573519843492. eCollection 2019.
Late recovery of consciousness in vegetative state is considered as an exceptional outcome and has been reported prevalently in patients who suffered a traumatic brain injury. In these patients, the benefits of prolonging the rehabilitation, aimed at the recovery of autonomy in basic everyday activities, has been demonstrated. Here, we describe the application of an intensive multi-professional rehabilitation program carried out on a young female patient, with exceptionally late recovery of consciousness, specifically, after 7 years of vegetative state due to severe brain hemorrhage. Neuropsychological and functional assessment was conducted before and after the end of the rehabilitation program. In addition, functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI)-based probabilistic tractography were performed. Two follow-up neuropsychological and functional assessments were also conducted 6 and 29 months after the conclusion of the program. Functional results showed an improvement, maintained over time, in walking with assistance, cognitive efficiency, visual acuity and visual field, dysarthria, and execution of activities of daily living. Moreover, functional and structural magnetic resonance imaging (MRI) data documented the existence of preserved neural networks involved in sensory, motor, and linguistic tasks, which in all likelihood support the recovery process. This report suggests the possibility of undertaking an intensive rehabilitation program in patients who remain for long periods in altered states of consciousness, in spite of early negative prognosis.
植物状态下意识的晚期恢复被视为一种罕见的结果，在创伤性脑损伤患者中普遍有报道。在这些患者中，延长康复治疗（旨在恢复基本日常活动的自主性）的益处已得到证实。在此，我们描述了对一名年轻女性患者实施的强化多专业康复计划，该患者意识恢复异常延迟，具体而言，是在因严重脑出血导致植物状态7年后。在康复计划结束前后进行了神经心理学和功能评估。此外，还进行了基于功能磁共振成像（fMRI）和扩散张量成像（DTI）的概率性纤维束成像。在该计划结束后的6个月和29个月还进行了两次随访神经心理学和功能评估。功能结果显示，在他人协助下行走、认知效率、视力和视野、构音障碍以及日常生活活动执行能力方面有改善，且这种改善随时间得以维持。此外，功能和结构磁共振成像（MRI）数据证明存在参与感觉、运动和语言任务的保留神经网络，这很可能支持了恢复过程。本报告表明，尽管早期预后不佳，但对于长期处于意识改变状态的患者，仍有可能开展强化康复计划。
