Combination of diffusion tensor and functional magnetic resonance imaging during recovery from the vegetative state.
BACKGROUND
The rate of recovery from the vegetative state (VS) is low. Currently, little is known of the mechanisms and cerebral changes that accompany those relatively rare cases of good recovery. Here, we combined functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) to study the evolution of one VS patient at one month post-ictus and again twelve months later when he had recovered consciousness.


METHODS
fMRI was used to investigate cortical responses to passive language stimulation as well as task-induced deactivations related to the default-mode network. DTI was used to assess the integrity of the global white matter and the arcuate fasciculus. We also performed a neuropsychological assessment at the time of the second MRI examination in order to characterize the profile of cognitive deficits.


RESULTS
fMRI analysis revealed anatomically appropriate activation to speech in both the first and the second scans but a reduced pattern of task-induced deactivations in the first scan. In the second scan, following the recovery of consciousness, this pattern became more similar to that classically described for the default-mode network. DTI analysis revealed relative preservation of the arcuate fasciculus and of the global normal-appearing white matter at both time points. The neuropsychological assessment revealed recovery of receptive linguistic functioning by 12-months post-ictus.


CONCLUSIONS
These results suggest that the combination of different structural and functional imaging modalities may provide a powerful means for assessing the mechanisms involved in the recovery from the VS.
Fernández-Espejo
Davinia
D
Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain.
Junque
Carme
C
Cruse
Damian
D
Bernabeu
Montserrat
M
Roig-Rovira
Teresa
T
Fábregas
Neus
N
Rivas
Eva
E
Mercader
Jose M
JM
D001921:Brain / Q000503:physiopathology*; D001930:Brain Injuries / Q000150:complications / Q000503:physiopathology; D038524:Diffusion Magnetic Resonance Imaging; D016489:Head Injuries, Closed / Q000150:complications / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D018458:Persistent Vegetative State / Q000209:etiology / Q000503:physiopathology*
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