Thalamic and extrathalamic mechanisms of consciousness after severe brain injury
Thalamic and extrathalamic mechanisms of consciousness after severe brain injury
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DOI：
10.1002/ana.24423
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发表时间：
2015-07-01
影响因子：
11.2
通讯作者：
Monti, Martin M.
中科院分区：
文献类型：
--
作者：
Lutkenhoff, Evan S.;Chiang, Jeffrey;Monti, Martin M.
目的重型颅脑损伤后意识丧失和恢复的机制是什么？我们试图在迄今为止最大的意识障碍(DOC)患者队列中，建立意识和觉醒的黄金标准临床测量与局部脑病理的特定模式之间的联系，从而可能为患者的诊断、预后和治疗发展提供一个机制框架。方法收集来自两个第三级专家中心的143名重型颅脑损伤患者(和96名志愿者)的结构性T1加权磁共振图像。研究对象包括(1)健康志愿者和患者、(2)临床实体(如植物状态、最低意识状态)、(3)临床意识指标(昏迷恢复量表修订版)和(4)损伤病因。结果与志愿者相比，患者在所有结构上均有显著萎缩(P<0.05)。
ObjectiveWhat mechanisms underlie the loss and recovery of consciousness after severe brain injury? We sought to establish, in the largest cohort of patients with disorders of consciousness (DOC) to date, the link between gold standard clinical measures of awareness and wakefulness, and specific patterns of local brain pathologythereby possibly providing a mechanistic framework for patient diagnosis, prognosis, and treatment development.MethodsStructural T1-weighted magnetic resonance images were collected, in a continuous sample of 143 severely brain-injured patients with DOC (and 96 volunteers), across 2 tertiary expert centers. Brain atrophy in subcortical regions (bilateral thalamus, basal ganglia, hippocampus, basal forebrain, and brainstem) was assessed across (1) healthy volunteers and patients, (2) clinical entities (eg, vegetative state, minimally conscious state), (3) clinical measures of consciousness (Coma Recovery Scale-Revised), and (4) injury etiology.ResultsCompared to volunteers, patients exhibited significant atrophy across all structures (p