Skip to main content

Functional Imaging and Impaired Consciousness

  • Chapter
  • First Online:

Abstract

Categorizing disorders of consciousness patients into the correct diagnostic syndrome is essential in determining prognosis and thus for accurate neurological management. Unfortunately, these patients are hardly distinguishable by means of behavioral testing alone, because they can be totally or partially aware, but unable to clearly produce appropriate motor outputs other than reflexive movements, as fluctuations of alertness. Sensory-motor impairments, use of drugs and severe general clinical conditions can strongly limit or mask the repertoire of their motor responses. All these reasons explain the high percentage of misdiagnosis, although several standardized neurobehavioral rating scales have been developed. Neuroimaging strategies cannot replace clinical evaluation, nevertheless they can describe objectively how deviant from normal patients’ cerebral activity is under various conditions of stimulation, at rest and during an active participation in simple tasks.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD   109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Schnakers C, Vanhaudenhuyse A, Giacino J, et al. Diagnostic accuracy of the vegetative and minimally conscious state: clinical consensus versus standardized neurobehavioral assessment. BMC Neurol. 2009;9:35.

    Article  PubMed  Google Scholar 

  2. Bruno M, Soddu A, Demertzi A, et al. Disorders of consciousness: moving from passive to resting state and active paradigms. Cogn Neurosci. 2010;1(3):193–203.

    Google Scholar 

  3. Laureys S, Lemaire C, Maquet P, et al. Cerebral metabolism during vegetative state and after recovery to consciousness. J Neurol Neurosurg Psychiatry. 1999;67:121.

    Article  PubMed  CAS  Google Scholar 

  4. Laureys S. The neural correlate of (un) awareness: lessons from the vegetative state. Trends Cogn Sci. 2005;9:556–9.

    Article  PubMed  Google Scholar 

  5. Laureys S, Goldman S, Phillips C, et al. Impaired effective cortical connectivity in vegetative state. Neuroimage. 1999;9:377–82.

    Article  PubMed  CAS  Google Scholar 

  6. Laureys S, Owen AM, Schiff ND. Brain function in coma, vegetative state, and related disorders. Lancet Neurol. 2004;3:537–46.

    Article  PubMed  Google Scholar 

  7. Nakayama N, Okumura A, Shinoda J, et al. 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. J Neurol Neurosurg Psychiatry. 2006;77:856–62.

    Article  PubMed  CAS  Google Scholar 

  8. Laureys S, Faymonville ME, Luxen A, et al. Restoration of thalamocortical connectivity after recovery from persistent vegetative state. Lancet. 2000;355:1790–1.

    Article  PubMed  CAS  Google Scholar 

  9. Silva S, Alacoque X, Fourcade O, et al. Wakefulness and loss of awareness: brain and brainstem interaction in the vegetative state. Neurology. 2010;74:313–20.

    Article  PubMed  CAS  Google Scholar 

  10. Bruno MA, Vanhaudenhuyse A, Schnakers C, et al. Visual fixation in the vegetative state: an observational case series PET study. BMC Neurol. 2010;10:35.

    Article  PubMed  Google Scholar 

  11. Raichle ME. Neuroscience. The brain’s dark energy. Science. 2006;314:1249–50.

    Article  PubMed  CAS  Google Scholar 

  12. Gusnard DA, Raichle ME. Searching for a baseline: functional imaging and the resting human brain. Nat Rev Neurosci. 2001;2:685–94.

    Article  PubMed  CAS  Google Scholar 

  13. Drevets WC, Burton H, Videen TO, et al. Blood flow changes in human somatosensory cortex during anticipated stimulation. Nature. 1995;373:249–52.

    Article  PubMed  CAS  Google Scholar 

  14. Mason MF, Norton MI, Van Horn JD, et al. Wandering minds: the default network and stimulus-independent thought. Science. 2007;315:393–5.

    Article  PubMed  CAS  Google Scholar 

  15. Vanhaudenhuyse A, Demertzi A, Schabus M, et al. Two distinct neuronal networks mediate the awareness of environment and of self. J Cogn Neurosci. 2011;23:570–8.

    Article  PubMed  Google Scholar 

  16. Boly M, Tshibanda L, Vanhaudenhuyse A, et al. Functional connectivity in the default network during resting state is preserved in a vegetative but not in a brain dead patient. Hum Brain Mapp. 2009;30:2393–400.

    Article  PubMed  CAS  Google Scholar 

  17. Fransson P, Marrelec G. The precuneus/posterior cingulate cortex plays a pivotal role in the default mode network: evidence from a partial correlation network analysis. Neuroimage. 2008;42:1178–84.

    Article  PubMed  Google Scholar 

  18. Vanhaudenhuyse A, Noirhomme Q, Tshibanda LJ, et al. Default network connectivity reflects the level of consciousness in non- communicative brain-damaged patients. Brain. 2010;133:161–71.

    Article  PubMed  Google Scholar 

  19. Cauda F, Micon BM, Sacco K, et al. Disrupted intrinsic functional connectivity in the vegetative state. J Neurol Neurosurg Psychiatry. 2009;80:429–31.

    Article  PubMed  CAS  Google Scholar 

  20. Hagmann P, Cammoun L, Gigandet X, et al. Mapping the structural core of human cerebral cortex. PLoS Biol. 2008;6:e159.

    Article  PubMed  Google Scholar 

  21. Horovitz SG, Fukunaga M, de Zwart JA, et al. Low frequency BOLD fluctuations during ­resting wakefulness and light sleep: a simultaneous EEG-fMRI study. Hum Brain Mapp. 2008;29:671–82.

    Article  PubMed  Google Scholar 

  22. Vincent JL, Patel GH, Fox MD, et al. Intrinsic functional architecture in the anaesthetized monkey brain. Nature. 2007;447:83–6.

    Article  PubMed  CAS  Google Scholar 

  23. Greicius MD, Kiviniemi V, Tervonen O, et al. Persistent default-mode network connectivity during light sedation. Hum Brain Mapp. 2008;29:839–47.

    Article  PubMed  Google Scholar 

  24. Horovitz SG, Braun AR, Carr WS, et al. Decoupling of the brain’s default mode network during deep sleep. Proc Natl Acad Sci USA. 2009;106:11376–81.

    Article  PubMed  CAS  Google Scholar 

  25. Soddu A, Vanhaudenhuyse A, Bahri MA, Bruno MA, Boly M, Demertzi A, Tshibanda JF, Phillips C, Stanziano M, Ovadia-Caro S, Nir Y, Maquet P, Papa M, Malach R, Laureys S, Noirhomme Q. Identifying the default-mode component in spatial IC analyses of patients with disorders of consciousness. Hum Brain Mapp. 2012;33:778–96.

    Article  PubMed  Google Scholar 

  26. Coleman MR, Rodd JM, Davis MH, et al. Do vegetative patients retain aspects of language comprehension? Evidence from fMRI. Brain. 2007;130:2494–507.

    Article  PubMed  Google Scholar 

  27. Di HB, Yu SM, Weng XC, et al. Cerebral response to patient’s own name in the vegetative and minimally conscious states. Neurology. 2007;68:895–9.

    Article  PubMed  CAS  Google Scholar 

  28. Fernandez-Espejo D, Junque C, Vendrell P, et al. Cerebral response to speech in vegetative and minimally conscious states after traumatic brain injury. Brain Inj. 2008;22:882–90.

    Article  PubMed  Google Scholar 

  29. Moritz CH, Rowley HA, Haughton VM, et al. Functional MR imaging assessment of a non-responsive brain injured patient. Magn Reson Imaging. 2001;19:1129–32.

    Article  PubMed  CAS  Google Scholar 

  30. Boly M, Faymonville ME, Peigneux P, et al. Auditory processing in severely brain injured patients: differences between the minimally conscious state and the persistent vegetative state. Arch Neurol. 2004;61:233–8.

    Article  PubMed  Google Scholar 

  31. Laureys S, Faymonville ME, Degueldre C, et al. Auditory processing in the vegetative state. Brain. 2000;123(8):1589–601.

    Article  PubMed  Google Scholar 

  32. Owen AM, Menon DK, Johnsrude IS, et al. Detecting residual cognitive function in persistent vegetative state. Neurocase. 2002;8:394–403.

    Article  PubMed  Google Scholar 

  33. Boly M, Faymonville ME, Schnakers C, et al. Perception of pain in the minimally conscious state with PET activation: an observational study. Lancet Neurol. 2008;7(11):1013–20.

    Article  PubMed  Google Scholar 

  34. Laureys S, Faymonville ME, Peigneux P, et al. Cortical processing of noxious somatosensory stimuli in the persistent vegetative state. Neuroimage. 2002;17(2):732–41.

    Article  PubMed  CAS  Google Scholar 

  35. Laureys S, Perrin F, Faymonville ME, et al. Cerebral processing in the minimally conscious state. Neurology. 2004;63:916–8.

    Article  PubMed  CAS  Google Scholar 

  36. Bekinschtein T, Leiguarda R, Armony J, et al. Emotion processing in the minimally conscious state. J Neurol Neurosurg Psychiatry. 2004;75:788.

    Article  PubMed  CAS  Google Scholar 

  37. Schiff ND, Rodriguez-Moreno D, Kamal A, et al. FMRI reveals large-scale network activation in minimally conscious patients. Neurology. 2005;64:514–23.

    Article  PubMed  CAS  Google Scholar 

  38. Qin P, Di H, Liu Y, et al. Anterior cingulate activity and the self in disorders of consciousness. Hum Brain Mapp. 2010;31:1993–2002.

    Article  PubMed  Google Scholar 

  39. Menon DK, Owen AM, Williams EJ, et al. Cortical processing in persistent vegetative state. Lancet. 1998;352:200.

    Article  PubMed  CAS  Google Scholar 

  40. Di H, Boly M, Weng X, et al. Neuroimaging activation studies in the vegetative state: predictors of recovery? Clin Med. 2008;8:502–7.

    PubMed  Google Scholar 

  41. Owen AM, Coleman MR, Boly M, et al. Detecting awareness in the vegetative state. Science. 2006;313:1402.

    Article  PubMed  CAS  Google Scholar 

  42. Boly M, Coleman MR, Davis MH, et al. When thoughts become action: an fMRI paradigm to study volitional brain activity in non- communicative brain injured patients. Neuroimage. 2007;36:979–92.

    Article  PubMed  CAS  Google Scholar 

  43. Hauk O, Johnsrude I, Pulvermuller F. Somatotopic representation of action words in human motor and premotor cortex. Neuron. 2004;41:301–7.

    Article  PubMed  CAS  Google Scholar 

  44. Weiskopf N, Mathiak K, Bock SW, et al. Principles of a brain- computer interface (BCI) based on real-time functional magnetic resonance imaging (fMRI). IEEE Trans Biomed Eng. 2004;51:966–70.

    Article  PubMed  Google Scholar 

  45. Owen A, Coleman M, Boly M, et al. Response to comments on detecting awareness in the vegetative state. Science. 2007;315:1221.

    Article  CAS  Google Scholar 

  46. Monti MM, Vanhaudenhuyse A, Coleman MR, et al. Willful modulation of brain activity in disorders of consciousness. N Engl J Med. 2010;362:579–89.

    Article  PubMed  CAS  Google Scholar 

  47. Majerus S, Bruno MA, Schnakers C, et al. The problem of aphasia in the assessment of ­consciousness in brain-damaged patients. Prog Brain Res. 2009;177:49–61.

    Article  PubMed  Google Scholar 

  48. Bardin JC, Fins JJ, Katz DI, Hersh J, Heier LA, Tabelow K, Dyke JP, Ballon DJ, Schiff ND, Voss HU. Dissociations between behavioural and functional magnetic resonance imaging-based evaluations of cognitive function after brain injury. Brain. 2011;134:769–82.

    Article  PubMed  Google Scholar 

  49. Monti MM, Coleman MR, Owen AM. Neuroimaging and the vegetative state: resolving the behavioral assessment dilemma? Ann NY Acad Sci. 2009;1157:81–9.

    Article  PubMed  Google Scholar 

  50. Owen AM, Coleman MR. Functional neuroimaging of the vegetative state. Nat Rev Neurosci. 2008;9:235–43 Schnackers.

    Article  PubMed  CAS  Google Scholar 

  51. Tshibanda L, Vanhaudenhuyse A, Boly M, et al. Neuroimaging after coma. Neuroradiology. 2010;52:15–24.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Audrey Vanhaudenhuyse Ph.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer-Verlag London

About this chapter

Cite this chapter

Vanhaudenhuyse, A. et al. (2012). Functional Imaging and Impaired Consciousness. In: Schnakers, C., Laureys, S. (eds) Coma and Disorders of Consciousness. Springer, London. https://doi.org/10.1007/978-1-4471-2440-5_3

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-2440-5_3

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-2439-9

  • Online ISBN: 978-1-4471-2440-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics