Department of Rehabilitation Medicine, Nantong First People's Hospital, Nantong, China.
Department of Rehabilitation Medicine, Xuan Wu Hospital, Capital Medical University, Beijing, China.
Brain Topogr. 2024 Nov 25;38(1):17. doi: 10.1007/s10548-024-01087-7.
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).
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.
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).
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.
观察不同意识水平严重脑损伤患者关键脑区的功能差异，为确定长程意识障碍（pDoC）的客观诊断指标提供参考。
前瞻性研究纳入我院康复医学科收治的 pDoC 患者。根据诊断标准和行为量表评估意识水平和临床结局。对 30 例不同意识水平的患者进行静息态功能磁共振成像（rs-fMRI）和弥散张量成像（DTI）检查。根据 12 个月随访时是否恢复意识将患者分为意识组和无意识组。
共纳入 30 例患者，其中无反应觉醒综合征/植物状态 8 例，最小意识状态 8 例，最小意识状态出现 6 例，闭锁综合征 8 例。意识组 19 例，无意识组 11 例。与无意识组相比，意识组左侧基底核激活，白质纤维束差异有统计学意义。小脑区域一致性（ReHo）值与格拉斯哥昏迷量表评分呈正相关（r = 0.387，P = 0.038），左侧颞叶 ReHo 值与昏迷恢复量表修订评分呈正相关（r = 0.394，P = 0.035）。
左侧脑岛和小脑可能对恢复意识至关重要。关键脑区的脑功能活动和结构重塑以及小脑的激活水平与临床行为相关，对 pDoC 患者的预后预测具有潜在应用价值。
