Prediction of recovery from post-traumatic vegetative state with cerebral magnetic-resonance imaging

Kampfl, A.; Schmutzhard, Erich; Franz, Gerhard; Pfausler, Bettina; Haring, Hans‐Peter; Ulmer, Hanno; Felber, Stefan; Golaszewski, Stefan; Aichner, F.

doi:10.1016/s0140-6736(97)10301-4

Cited by 213 publications

(120 citation statements)

References 22 publications

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“…Older studies have shown the possible prognostic value of 'classic' structural MRI sequences to predict DOC outcome; for example, the presence of corpus callosum and dorsolateral brainstem lesions correlates with lack of recovery at the group level. 63 However, recently developed quantitative diffusion tensor imaging (DTI) techniques, which permit assessment of structural white matter damage, have been shown to outperform clinical markers in predicting 1-year functional outcome at the individual-patient level in patients with traumatic 64 or anoxic 65 brain injury. In our view, DTI-MRI techniques offer a unique opportunity to quantify the structural integrity of the white matter, and can also quantify the primary and secondary axonal damage encountered in DOC.…”

Section: Structural Imagingmentioning

confidence: 99%

Disorders of consciousness after acquired brain injury: the state of the science

et al. 2014

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| The concept of consciousness continues to defy definition and elude the grasp of philosophical and scientific efforts to formulate a testable construct that maps to human experience. Severe acquired brain injury results in the dissolution of consciousness, providing a natural model from which key insights about consciousness may be drawn. In the clinical setting, neurologists and neurorehabilitation specialists are called on to discern the level of consciousness in patients who are unable to communicate through word or gesture, and to project outcomes and recommend approaches to treatment. Standards of care are not available to guide clinical decision-making for this population, often leading to inconsistent, inaccurate and inappropriate care. In this Review, we describe the state of the science with regard to clinical management of patients with prolonged disorders of consciousness. We review consciousness-altering pathophysiological mechanisms, specific clinical syndromes, and novel diagnostic and prognostic applications of advanced neuroimaging and electrophysiological procedures. We conclude with a provocative discussion of bioethical and medicolegal issues that are unique to this population and have a profound impact on care, as well as raising questions of broad societal interest.

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Section: Structural Imagingmentioning

confidence: 99%

Disorders of consciousness after acquired brain injury: the state of the science

et al. 2014

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“…Several studies [11][12][13]29,30 have postulated that brain stem lesions appear to be the most potent markers of poor prognosis, most notably when they are bilateral and symmetrical. In our series, bilateral brain stem injuries observed on MR imaging also had a high predictive value (100%) for a poor outcome, as all patients with bilateral involvement experienced a poor outcome.…”

Section: 12mentioning

confidence: 99%

“…9 Concerning prognosis, the brain stem is one of the most commonly studied anatomic structures. 10 Most of the series published in the literature [11][12][13][14][15][16] report that lesions in the brain stem are associated with a worse global prognosis and less probability of recovering from a vegetative state. Those reports support the Ommaya-Gennarelli model, in which the depth of brain injury correlates with TBI morbidity and mortality.…”

mentioning

confidence: 99%

Severe Traumatic Head Injury: Prognostic Value of Brain Stem Injuries Detected at MRI

Hilario¹,

Ramos²,

Millan³

et al. 2012

AJNR Am J Neuroradiol

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“…Although the frequency of this finding may lead to speculation about its critical role in clinical outcomes (Kampfl et al, 1998), large splenial tumors (Yamamoto et al, 1990;Rudge and Warrington, 1991) and large unilateral cingulate tumors that greatly deform this region (Malamud, 1967) fail to alter consciousness. In view of these latter findings, it is doubtful that the vegetative state is a consequence of splenial and PCC damage.…”

Section: Epilepsy Stroke and Vegetative Statementioning

confidence: 99%

Posterior cingulate, precuneal and retrosplenial cortices: cytology and components of the neural network correlates of consciousness

Vogt

Laureys

2005

Progress in Brain Research

455

347

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Neuronal aggregates involved in conscious awareness are not evenly distributed throughout the CNS but are comprised of key components referred to as the neural network correlates of consciousness (NNCC). A critical node in this network is the retrosplenial, posterior cingulate, and precuneal cortices (RSC/PCC/PrCC). The cytological and neurochemical composition of this region is reviewed in relation to the Brodmann map. This region has the highest level of brain glucose metabolism and cytochrome c oxidase activity. Monkey studies suggest that the anterior thalamic projection likely drives RSC and PCC metabolism and that the midbrain projection to the anteroventral thalamic nucleus is a key coupling site between the brainstem system for arousal and cortical systems for cognitive processing and awareness. The pivotal role of RSC/PCC/PrCC in consciousness is demonstrated with posterior cingulate epilepsy cases, midcingulate lesions that deafferent this region and are associated with unilateral sensory neglect, observations from stroke and vegetative state patients, alterations in blood flow during sleep, and the actions of anesthetics. Since this region is critically involved in self reflection, it is not surprising that it is similarly a site for the NNCC. Interestingly, information processing during complex cognitive tasks and during aversive sensations such as pain induces efforts to terminate self reflection and result in decreased processing in PCC/PrCC. Finally, anatomical relations between the neural correlates of mind and NNCC in the cingulate gyrus do not appear to overlap and suggests that mental function and conscious awareness may be mediated by two neural networks.

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Prediction of recovery from post-traumatic vegetative state with cerebral magnetic-resonance imaging

Cited by 213 publications

References 22 publications

Disorders of consciousness after acquired brain injury: the state of the science

Disorders of consciousness after acquired brain injury: the state of the science

Severe Traumatic Head Injury: Prognostic Value of Brain Stem Injuries Detected at MRI

Posterior cingulate, precuneal and retrosplenial cortices: cytology and components of the neural network correlates of consciousness

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