Relationship between regional cerebral metabolism and consciousness disturbance in traumatic diffuse brain injury without large focal lesions: an FDG-PET study with statistical parametric mapping analysis.
BACKGROUND
The cerebral metabolism of patients in the chronic stage of traumatic diffuse brain injury (TDBI) has not been fully investigated.


OBJECTIVE
To study the relationship between regional cerebral metabolism (rCM) and consciousness disturbance in patients with TDBI.


METHODS
52 patients with TDBI in the chronic stage without large focal lesions were enrolled, and rCM was evaluated by fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) with statistical parametric mapping (SPM). All the patients were found to have disturbed consciousness or cognitive function and were divided into the following three groups: group A (n = 22), patients in a state with higher brain dysfunction; group B (n = 13), patients in a minimally conscious state; and group C (n = 17), patients in a vegetative state. rCM patterns on FDG-PET among these groups were evaluated and compared with those of normal control subjects on statistical parametric maps.


RESULTS
Hypometabolism was consistently indicated bilaterally in the medial prefrontal regions, the medial frontobasal regions, the cingulate gyrus and the thalamus. Hypometabolism in these regions was the most widespread and prominent in group C, and that in group B was more widespread and prominent than that in group A.


CONCLUSIONS
Bilateral hypometabolism in the medial prefrontal regions, the medial frontobasal regions, the cingulate gyrus and the thalamus may reflect the clinical deterioration of TDBI, which is due to functional and structural disconnections of neural networks rather than due to direct cerebral focal contusion.
Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital, 630 Shimokobi, Kobi-cho, Minokamo City, Gifu 505-0034, Japan. doctor.1@jasmine.ocn.ne.jp.
N
N
Nakayama
A
A
Okumura
J
J
Shinoda
T
T
Nakashima
T
T
Iwama
D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging / Q000378:metabolism*; D001930:Brain Injuries / Q000150:complications* / Q000000981:diagnostic imaging*; D001931:Brain Mapping; D003072:Cognition Disorders / Q000209:etiology / Q000378:metabolism; D003244:Consciousness Disorders / Q000209:etiology* / Q000378:metabolism*; D005260:Female; D019788:Fluorodeoxyglucose F18; D005947:Glucose / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012720:Severity of Illness Index
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D005947:Glucose