A human brain network derived from coma-causing brainstem lesions
A human brain network derived from coma-causing brainstem lesions
复制标题
DOI：
10.1212/wnl.0000000000003404
复制
发表时间：
2016-12-06
期刊：
影响因子：
9.9
通讯作者：
Geerling, Joel C.
中科院分区：
文献类型：
--
作者：
Fischer, David B.;Boes, Aaron D.;Geerling, Joel C.
目的：研究导致昏迷的脑干病变的特异性部位及其功能连接网络。方法：采用病例对照设计，利用基于体素的病变-症状图，比较12个引起昏迷的脑干病变和24个对照脑干病变，以确定与昏迷显著相关的部位。接下来，我们使用一个健康队列的静息状态功能连接来识别与这个脑干部位有功能连接的区域网络。我们进一步研究了这个网络的皮质区域，通过比较它们的空间地形和已知的网络，并通过评估它们在意识障碍患者中的功能连通性。结果：在吻侧桥背外侧被盖的一个小区域与引起昏迷的损害显著相关。在健康成人中，这个脑干部位在功能上与腹前脑岛(AI)和前扣带前皮质(PACC)相连。这些皮质区域与先前定义的静息状态网络的对准程度较差，与von Economo神经元的分布更匹配。最后，在意识障碍患者中，AI和pACC之间的连接被破坏，并且比其他脑网络更严重。结论：脑桥被盖小区域的损伤与昏迷显著相关。这个脑干部位在功能上连接到两个皮质区域，AI和pACC，这两个区域在意识障碍时变得分离。这一大脑区域网络可能在维持人类意识方面发挥作用。
Objective: To characterize a brainstem location specific to coma-causing lesions, and its functional connectivity network.Methods: We compared 12 coma-causing brainstem lesions to 24 control brainstem lesions using voxel-based lesion-symptom mapping in a case-control design to identify a site significantly associated with coma. We next used resting-state functional connectivity from a healthy cohort to identify a network of regions functionally connected to this brainstem site. We further investigated the cortical regions of this network by comparing their spatial topography to that of known networks and by evaluating their functional connectivity in patients with disorders of consciousness.Results: A small region in the rostral dorsolateral pontine tegmentum was significantly associated with coma-causing lesions. In healthy adults, this brainstem site was functionally connected to the ventral anterior insula (AI) and pregenual anterior cingulate cortex (pACC). These cortical areas aligned poorly with previously defined resting-state networks, better matching the distribution of von Economo neurons. Finally, connectivity between the AI and pACC was disrupted in patients with disorders of consciousness, and to a greater degree than other brain networks.Conclusions: Injury to a small region in the pontine tegmentum is significantly associated with coma. This brainstem site is functionally connected to 2 cortical regions, the AI and pACC, which become disconnected in disorders of consciousness. This network of brain regions may have a role in the maintenance of human consciousness.