RECONFIG - REcovery of CONsciousness Following Intracerebral hemorrhaGe

昏迷在急性脑损伤后很常见，比如脑出血，而且恢复得很差 明白了。这种知识的缺乏是制定新的改进战略的关键障碍。 预后，是预测意识恢复和功能恢复的主要原因之一 结果是不准确的。五分之一的临床昏迷的急性脑损伤患者能够跟随 使用简单的床边脑电运动成像测试直接测量相关大脑活动的命令 尝试着移动。这种状态被称为认知运动分离(CMD)。试点数据表明，CMD 患者更有可能在临床上恢复意识，并有更好的长期功能结果 非CMD患者。为了将这些发现整合到临床实践中，我们需要更好地了解这些轨迹 Cmd.这只有在一项严格控制的研究中才有可能，该研究具有相同的患者队列， 在受伤后早期表现为特征，并捕捉到长期结果。关于这一点的总体假设 应用是，一旦考虑到混杂因素，意识的恢复就会遵循一个可预测的过程 CMD(由脑电运动成像范式诊断)是一种从无意识到 意识的出现。描述复苏的轨迹将是这一计划的总体目标 申请。我们提出了一项双中心的观察性队列研究，研究对象为表现为初发疾病的患者 额叶、丘脑或纹状体囊区的脑出血(ICH) 其他区域(如中脑)出血。我们将把ICH患者分为两组-有意识的和 不省人事。在无意识队列中，我们将确定从受伤到临床指挥的时间 将时间以CMD作为时变协变量(目标1)，并确定CMD是否预测长期函数 结果(目标2)。在有意识的队列中，我们将确定感觉性失语患者是否能够表现出 使用脑电运动表象范式测试时的指令遵循(目标3)。回答提出的问题 目标1和目标2，我们将研究对命令无反应的脑出血患者。我们将确定地点和 静息EEG上的脑出血体积和电生理特征与发病时间有关。我们会 在控制已知的预测因素后，确定CMD是否独立预测6个月的修正Rankin评分。 为了达到目标3，我们将使用脑电运动对有和没有感觉性失语的清醒脑出血患者进行研究。 意象范式。该项目将确定CMD是否是一种患者可预见地过渡到AS的状态 他们从无意识恢复到有意识状态，并量化命令的假阴性率 在失语症患者中进行随访。这些见解将填补对损害的理解和 这种常见形式的中风的意识恢复很可能适用于其他脑损伤。

Unconsciousness is common after acute brain injury such as a brain hemorrhage, and recovery is poorly understood. This lack of knowledge is a key impediment to the development of novel strategies to improve outcomes, and is one of the main reasons that prognostication of recovery of consciousness and functional outcomes is inaccurate. One fifth of clinically unconscious patients with acute brain injury are able to follow commands using a simple, bedside EEG motor imagery test that directly measures brain activity associated with the attempt to move. This state is called cognitive motor dissociation (CMD). Pilot data indicates that CMD patients are more likely to clinically recover consciousness and have better long-term functional outcomes than non-CMD patients. To integrate these findings into clinical practice we need to better understand the trajectory of CMD. This will only be possible in a tightly-controlled study with a homogenous patient cohort that is well characterized early after the injury and captures long-term outcomes. The over-arching hypothesis of this application is that once confounders are accounted for, recovery of consciousness follows a predictable course with CMD (diagnosed by an EEG motor imagery paradigm) being a transitory state from unconsciousness to emergence of consciousness. Characterizing the trajectory of recovery will be the overall goal of this application. We propose a two-center, observational cohort study of patients presenting with primary intracerebral hemorrhage (ICH) in the frontal lobe, thalamus, or striatocapsular region who do not have major bleeding in other regions (e.g., midbrain). We will divide ICH patients into two cohorts- conscious and unconscious. In the unconscious cohort, we will determine the time from injury to clinical command following with time to CMD as a time-varying covariate (Aim 1), and determine if CMD predicts long-term functional outcome (Aim 2). In the conscious cohort we will determine if patients with sensory aphasia are able to show command following when tested with the EEG motor imagery paradigm (Aim 3). To answer questions posed in Aims 1 and 2, we will study ICH patients that are unresponsive to commands. We will determine if location and volume of ICH and electrophysiological features on resting EEG are associated with time to CMD. We will determine if CMD independently predicts 6-month modified Rankin Scale after controlling for known predictors. To address Aim 3 we will study conscious ICH patients with and without sensory aphasia using the EEG motor imagery paradigm. This project will determine if CMD is a state that patients predictably transition through as they recover from an unconscious to a conscious state and quantify the false negative rate for command following in aphasic patients. These insights will fill an important gap in the understanding of impairment and recovery of consciousness of this common form of stroke that will likely be generalizable to other brain injuries.