Correlations between diffusion tensor imaging and levels of consciousness in patients with traumatic brain injury: a systematic review and meta-analysis

Zhang, Jie; Wei, Rui-Li; Peng, Guoping; Zhou, Jue-Yu; Wu, Min; He, Fangping; Pan, Gang; Gao, Jian; Luo, Benyan

doi:10.1038/s41598-017-02950-3

Cited by 26 publications

(26 citation statements)

References 52 publications

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“…A meta-analysis recently demonstrated that FA correlates better with consciousness levels compared with other MRI tools like apparent diffusion coefficient (ADC) in patients with traumatic brain injury (TBI). [20] However, it also showed that the degree of correlation varies among brain regions. Multiple manual and automatic protocols have been reported for the reconstruction of the ARAS with DTT aiming to correlate radiological findings with the level of consciousness after a TBI or stroke.…”

Section: Discussionmentioning

confidence: 99%

Structural and functional connectivity of ascending reticular activating system in a patient with impaired consciousness after a cardiac arrest

et al. 2019

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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.

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Section: Discussionmentioning

confidence: 99%

Structural and functional connectivity of ascending reticular activating system in a patient with impaired consciousness after a cardiac arrest

et al. 2019

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“…Damage to the hippocampal commissure, combined with the loss of visuospatial and auditory information transfer in splenial pathology and further disintegration of the cerebral network, may lead to changes in consciousness. Using DTI, Zhang et al determined that consciousness levels correlated strongly with a reduction of fractional anisotropy value in the corpus of the CC and moderately in the splenium, corresponding with increased demyelination [28]. Acute severing of the crossing fibers following head trauma has been shown to lead to altered mental status and even coma [29].…”

Section: Consciousnessmentioning

confidence: 99%

The splenium of the corpus callosum: embryology, anatomy, function and imaging with pathophysiological hypothesis

Blaauw

Meiners

2020

Neuroradiology

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Background and purpose The splenium of the corpus callosum is the most posterior part of the corpus callosum. Its embryological development, anatomy, vascularization, function, imaging of pathology, possible pathophysiological mechanisms by which pathology may develop and the clinical consequences are discussed. Methods A literature-based description is provided on development, anatomy and function. MR and CT images are used to demonstrate pathology. The majority of pathology, known to affect the splenium, and the clinical effects are described in three subsections: (A) limited to the splenium, with elaboration on pathophysiology of reversible splenial lesions, (B) pathology in the cerebral white matter extending into or deriving from the splenium, with special emphasis on tumors, and (C) splenial involvement in generalized conditions affecting the entire brain, with a hypothesis for pathophysiological mechanisms for the different diseases.Results The development of the splenium is preceded by the formation of the hippocampal commissure. It is bordered by the falx and the tentorium and is perfused by the anterior and posterior circulation. It contains different caliber axonal fibers and the most compact area of callosal glial cells. These findings may explain the affinity of specific forms of pathology for this region. The fibers interconnect the temporal and occipital regions of both hemispheres reciprocally and are important in language, visuospatial information transfer and behavior. Acquired pathology may lead to changes in consciousness. Conclusion The development, location, fiber composition and vascularization of the splenium make it vulnerable to specific pathological processes. It appears to play an important role in consciousness. AbbreviationAC anterior commissure ACC agenesis of the corpus callosum ADEM acute disseminated encephalomyelitis ADH anti-diuretic hormone AED anti-epileptic drugs AVP arginine-vasopressin CC corpus callosum CLOCC cytotoxic lesions of the corpus callosum DLBCL diffuse large B cell lymphoma GBM glioblastoma multiforme HC hippocampal commissure HIE hypoxic ischemic encephalopathy MERS mild encephalitis/encephalopathy with a reversible splenial lesion PCNSL primary central nervous system lymphoma RESLES reversible splenial lesions syndrome

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“…Over the last 20 years many studies have investigated the ability of clinical signs and technologically based physiological tests to detect and measure awareness. There have been at least five relevant systematic reviews [17][18][19][20][21], shown in Table 2.…”

Section: The Evidence: Signs and Testsmentioning

confidence: 99%

How often is the diagnosis of the permanent vegetative state incorrect? A review of the evidence

Wade

2018

Euro J of Neurology

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Some research suggests that 40% of people in the vegetative state are misdiagnosed. This review investigates the frequency, nature and causes of reported misdiagnosis of patients in the vegetative state, focusing on the nature of the error. It is a systematic review of all relevant literature, using references from key papers identified. The data are summarized in tables. Five clinical studies of the rate of misdiagnosis in practice were identified, encompassing 236 patients in the vegetative state of whom 80 (34%) were reclassified as having some awareness, often minimal. The studies often included patients in the recovery phase after acute injury, and were poorly reported. Five systematic reviews of signs and technologically based neurophysiological tests were identified, and they showed that most studies were small, lacked accurate or important details, and were subject to bias. Studies were not replicated. Many signs and tests did not differ between people in the vegetative state and in the minimally conscious state, and those that did were unable to diagnose an individual patient. The few single case reports suggest that failure to ensure an accurate diagnosis of the underlying neurological damage and dysfunction could, rarely, lead to significant misdiagnosis usually in patients who had brain-stem damage with little thalamic or cortical damage. Significant misdiagnosis of awareness, with an apparently 'vegetative' patient having good awareness, is rare. Careful neurological assessment of the cause and routine measurement of awareness using the Coma Recovery Scale - Revised should further reduce mistakes.

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Correlations between diffusion tensor imaging and levels of consciousness in patients with traumatic brain injury: a systematic review and meta-analysis

Cited by 26 publications

References 52 publications

Structural and functional connectivity of ascending reticular activating system in a patient with impaired consciousness after a cardiac arrest

Structural and functional connectivity of ascending reticular activating system in a patient with impaired consciousness after a cardiac arrest

The splenium of the corpus callosum: embryology, anatomy, function and imaging with pathophysiological hypothesis

How often is the diagnosis of the permanent vegetative state incorrect? A review of the evidence

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