RECONFIG - REcovery of CONsciousness Following Intracerebral hemorrhaGe

意识丧失在急性脑损伤如脑出血后很常见，而且恢复很差 明白这种知识的缺乏是发展新战略的关键障碍， 结果，是意识和功能恢复的主要原因之一， 结果不准确。五分之一的急性脑损伤临床无意识患者能够遵循 使用简单的床边EEG运动想象测试命令，该测试直接测量相关的大脑活动。 试图移动。这种状态被称为认知运动分离（CMD）。试验数据表明，CMD 患者在临床上更有可能恢复意识，并且具有更好的长期功能结局， 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 的CMD。这只有在一项严格对照的研究中才有可能，该研究采用同质患者队列， 在受伤后早期进行表征，并捕获长期结果。这种过度假设 一旦考虑到混杂因素，意识恢复遵循可预测的过程 CMD（通过EEG运动想象范例诊断）是从无意识到 意识的出现。描述复苏的轨迹将是本报告的总体目标。 应用程序.我们提出了一个双中心，观察性队列研究的患者表现为原发性 额叶、丘脑或纹状体囊区脑内出血（ICH）， 其他区域出血（例如，中脑）。我们将ICH患者分为两个队列-清醒和 昏迷在无意识队列中，我们将确定从受伤到临床命令的时间， 以至CMD的时间作为时变协变量（目标1），并确定CMD是否预测长期功能性 （目标2）。在有意识的队列中，我们将确定感觉性失语症患者是否能够显示 当用EEG运动想象范式（目标3）测试时，命令如下。回答在 目标1和2，我们将研究对命令无反应的ICH患者。我们将确定位置和 ICH的体积和静息EEG的电生理特征与CMD的时间相关。我们将 在控制已知预测因素后，确定CMD是否独立预测6个月的改良兰金量表。 为了解决目标3，我们将使用EEG运动研究伴有和不伴有感觉性失语的清醒ICH患者， 意象范式该项目将确定CMD是否是一种患者可预测的过渡状态， 他们从无意识状态恢复到有意识状态，并量化命令的假阴性率， 在失语症患者中。这些见解将填补理解障碍的重要空白， 这种常见形式的中风的意识恢复可能会推广到其他脑损伤。

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.