In this paper, we present a novel approach for functional network connectivity in fMRI resting activity using distance correlation. The proposed method accounts for nonlinear relationships between the resting state networks and can be used for both single subject and group level analyses. We showed that the new strategy improves the capacity of characterization of pathological populations, such as, patients with disorder of consciousness, when compared to related approaches.
Rationale:
Diffusion tensor imaging (DTI), diffusion tensor tractography (DTT), as well as resting-state-functional magnetic resonance imaging (rsfMRI) are promising methods for assessing patients with disorders of consciousness (DOCs).
Patient concerns:
This work describes the main findings using DTI, DTT, and rsfMRI in a patient with a DOC secondary to an anoxic encephalopathy who had a fatal outcome. She was an 85-year-old woman who presented a cardiac arrest and underwent cardiopulmonary resuscitation for 20 minutes then returning to spontaneous circulation. After sedation withdrawal, 2 days after the event, she remained with a Glasgow Coma Scale score of 3/15 and with an absence of brainstem reflexes.
Diagnoses:
DOC secondary to an anoxic encephalopathy after cardiovascular resuscitation.
Interventions:
A complete brain MRI scan was performed 72 hours after the initial event, including DTI, DTT, and rsfMRI. DTT demonstrated disruption of both ventral and dorsal tegmental tracts bilaterally. DTI showed a reduction of fractional anisotropic level in the mesencephalic nuclei. Moreover, changes in the number of fiber tracts were not evidenced in any portions of the ascending reticular activating system (ARAS). Finally, an increase in the anticorrelated and correlated association among the nuclei in the ARAS and the cortex was evidenced.
Outcomes:
Patient deceased.
Lessons:
Neuroimaging demonstrated low FA values in the ARAS, destruction of dorsal and ventral tegmental tracts, as well as hyper-connective (highly correlated or anti-correlated) association among ARAS and cortical nuclei compared with 3 healthy control subjects.
Recent evidence on resting-state functional magnetic resonance imaging (rs-fMRI) suggests that healthy human brains have a temporal organization represented in a widely complex time-delay structure. This structure seems to underlie brain communication flow, integration/propagation of brain activity, as well as information processing. Therefore, it is probably linked to the emergence of highly coordinated complex brain phenomena, such as consciousness. Nevertheless, possible changes in this structure during an altered state of consciousness remain poorly investigated. In this work, we hypothesized that due to a disruption in high-order functions and alterations of the brain communication flow, patients with disorders of consciousness (DOC) might exhibit changes in their time-delay structure of spontaneous brain activity. We explored this hypothesis by comparing the time-delay projections from fMRI resting-state data acquired in resting state from 48 patients with DOC and 27 healthy controls (HC) subjects. Results suggest that time-delay structure modifies for patients with DOC conditions when compared with HC. Specifically, the average value and the directionality of latency inside the midcingulate cortex (mCC) shift with the level of consciousness. In particular, positive values of latency inside the mCC relate to preserved states of consciousness, whereas negative values change proportionally with the level of consciousness in patients with DOC. These results suggest that the mCC may play a critical role as an integrator of brain activity in HC subjects, but this role vanishes in an altered state of consciousness.
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