Chronic disorders of consciousness: a case report with longitudinal evaluation of disease progression using 7 T magnetic resonance imaging

BMC Neurology

Xufei Tan¹  Xiaoxia Li²  Benyan Luo²  Xiaohua Hu³  Yan Dong³  Pinyi Wang⁴  Xiaotong Zhang⁵ 

[1] Department of Clinical Medicine, Zhejiang University City College School of Medicine, Hangzhou, China;Department of Neurology and Brain Medical Centre, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Road, 310003, Hangzhou, China;Department of Rehabilitation, Hangzhou Hospital of Zhejiang CAPR, Hangzhou, China;Interdisciplinary Institute of Neuroscience and Technology, Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China;Interdisciplinary Institute of Neuroscience and Technology, Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China;School of Medicine, Zhejiang University, Hangzhou, China;

关键词: Arcuate fasciculus;    Connectome;    Diffusion;    Disorders of consciousness;    Severe brain injury;    Superior longitudinal fasciculus;    Traumatic brain injury;   

DOI  :  10.1186/s12883-020-01973-0

来源: Springer

【 摘 要 】

BackgroundOutcome prediction for patients with disorders of consciousness (DOC) is essential yet challenging. Evidence showed that patients with DOC lasting 1 year or longer after a brain injury were less likely to recover. However, the reasons why outcomes of DOC patients differ greatly remain unclear. With a variety of analytical methods and through quantitative behavioral assessments, we aimed to track the progression of a patient with severe brain injury, in order to advance our understanding of the underlying mechanisms of DOC.Case presentationWe performed a longitudinal study for a 52-year-old male DOC patient who has remained in the state for 1.5 years with comprehensive rehabilitative therapies. The patient underwent 3 times of assessments of Coma Recovery Scale-Revised (CRS-R) and ultra-high-field 7 T magnetic resonance imaging (MRI). Both topologic properties and brain microstructure were analyzed to track disease progression. We observed dynamic increases of fiber densities with measurements at three time points (t1:1.5 M, t2:7.5 M t3:17.5 M). Specifically, fiber densities of the superior longitudinal fasciculus and arcuate fasciculus nerve fiber bundles improved mostly in the visual, verbal, and auditory subscales, which was consistent with the CRS-R scores. Moreover, the graph-theory analyses demonstrated that network topologic properties showed an improvement although the disease duration exceeded 1 year.ConclusionsDOC patients with a course longer than 1 year remain possible to improve, and including evaluation methods such as WM connectome analysis and graph theory could be potentially valuable for a more precise assessment of patients with a longer course of DOC.

【 授权许可】

CC BY