Visual fixation in the vegetative state: an observational case series PET study.
Visual fixation in the vegetative state: an observational case series PET study.
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DOI：
10.1186/1471-2377-10-35
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发表时间：
2010-05-26
期刊：
影响因子：
2.6
通讯作者：
Laureys S
中科院分区：
文献类型：
--
作者：
Bruno MA;Vanhaudenhuyse A;Schnakers C;Boly M;Gosseries O;Demertzi A;Majerus S;Moonen G;Hustinx R;Laureys S
视觉注视的评估通常用于意识障碍患者的临床检查。然而，不同的国际指南似乎不同意固定是否与植物人状态的诊断相一致（即，代表“自动”皮层下处理）或者是意识和更高级皮层处理的充分标志。我们在此研究了10名慢性缺氧后脑病患者和39名年龄匹配的健康对照者的脑代谢。五名患者处于植物人状态（无注视），五名患者出现视觉注视，但在其他方面表现出植物人状态的所有典型标准。患者的年龄、病因和自损伤后的时间相匹配，并随后进行至少1年的重复昏迷恢复量表修订版（CRS-R）评估。根据CRS-R标准，当眼睛重新注视移动目标超过2秒时，认为存在持续的视觉注视。没有固定的患者在广泛的额顶叶皮质网络中表现出代谢功能障碍（仅保留脑干和小脑），这与视觉固定患者的脑功能没有不同。两组患者的皮质-皮质功能连接与视觉皮质之间没有差异。无固定和有固定的患者之间的恢复率没有差异（无患者显示良好结局）。我们的研究结果表明，持续的视觉固定（非创伤性）的意识障碍并不一定反映意识和更高层次的大脑皮层功能。
Assessment of visual fixation is commonly used in the clinical examination of patients with disorders of consciousness. However, different international guidelines seem to disagree whether fixation is compatible with the diagnosis of the vegetative state (i.e., represents "automatic" subcortical processing) or is a sufficient sign of consciousness and higher order cortical processing. We here studied cerebral metabolism in ten patients with chronic post-anoxic encephalopathy and 39 age-matched healthy controls. Five patients were in a vegetative state (without fixation) and five presented visual fixation but otherwise showed all criteria typical of the vegetative state. Patients were matched for age, etiology and time since insult and were followed by repeated Coma Recovery Scale-Revised (CRS-R) assessments for at least 1 year. Sustained visual fixation was considered as present when the eyes refixated a moving target for more than 2 seconds as defined by CRS-R criteria. Patients without fixation showed metabolic dysfunction in a widespread fronto-parietal cortical network (with only sparing of the brainstem and cerebellum) which was not different from the brain function seen in patients with visual fixation. Cortico-cortical functional connectivity with visual cortex showed no difference between both patient groups. Recovery rates did not differ between patients without or with fixation (none of the patients showed good outcome). Our findings suggest that sustained visual fixation in (non-traumatic) disorders of consciousness does not necessarily reflect consciousness and higher order cortical brain function.
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影响因子：
2.6
作者：
Schnakers C;Vanhaudenhuyse A;Giacino J;Ventura M;Boly M;Majerus S;Moonen G;Laureys S
通讯作者：
Laureys S
影响因子：
4.8
作者：
Laureys S;Giacino JT;Schiff ND;Schabus M;Owen AM
通讯作者：
Owen AM
影响因子：
2.6
作者：
Kentridge, R. W.;Nijboer, T. C. W.;Heywood, C. A.
通讯作者：
Heywood, C. A.
影响因子：
5.3
作者：
Kincade, JM;Abrams, RA;Corbetta, M
通讯作者：
Corbetta, M
植物人状态下大脑皮层的有效连通性受损： 使用 PET 进行初步研究
影响因子：
5.7
作者：
Laureys, S;Goldman, S;Maquet, P
通讯作者：
Maquet, P