MRI Default Mode Network Connectivity is Associated with Functional Outcome After Cardiopulmonary Arrest

Koenig, Matthew A.; Holt, John L.; Ernst, Thomas; Buchthal, Steven; Nakagawa, Kazuma; Stenger, V. Andrew; Chang, Linda

doi:10.1007/s12028-014-9953-3

Cited by 61 publications

(67 citation statements)

References 39 publications

(43 reference statements)

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“…47 Two studies evaluated the predictive value of functional connectivity in comatose patients after cardiac arrest. 19,30 In the first of these, preservation of intrinsic DMN connectivity accurately discriminated comatose patients who regained consciousness from those who did not. 30 In the second, a significant association was noted between connectivity strength in the PCC and precuneus and functional status at hospital discharge.…”

Section: Systematic Review Population Characteristicsmentioning

confidence: 99%

“…Sedation was reported in 7 studies (78 subjects) and included propofol, fentanyl, phenobarbital, midazolam, and diazepam. 16,17,19,30,43,48,49 Resting-state image acquisition and analysis. Restingstate brain activity was evaluated with fMRI in 16 studies (292 subjects, 295 HCs).…”

Section: Systematic Review Population Characteristicsmentioning

confidence: 99%

“…DMN resting functional connectivity and size (number of voxels inside the DMN) were significantly reduced in patients with DOC compared with HCs. 16,18,19,21,23,24,30,33,40 Two of these studies exclusively evaluated patients with anoxic brain injury; both demonstrated decreased connectivity within the DMN. 19,30 Studies demonstrated a relationship between the degree of impaired consciousness and DMN connectivity, with greater reductions in connectivity in VS compared with MCS.…”

Section: Systematic Review Population Characteristicsmentioning

confidence: 99%

“…16,18,19,21,23,24,30,33,40 Two of these studies exclusively evaluated patients with anoxic brain injury; both demonstrated decreased connectivity within the DMN. 19,30 Studies demonstrated a relationship between the degree of impaired consciousness and DMN connectivity, with greater reductions in connectivity in VS compared with MCS. 23,33,40 In one study, functional connectivity of the PCC and precuneus was linked to the severity of consciousness impairment, differentiating among VS, MCS, coma, and HC.…”

Section: Systematic Review Population Characteristicsmentioning

confidence: 99%

“…The relationship between functional neuroimaging data and outcome was assessed in a small number of studies (table 1). 19,30,47,49,51 Among reports using an ROI-based analysis, one found no correlation between regional activity and recovery of consciousness in VS and comatose patients, 49 a second study found more pronounced frontal lobe hypoperfusion in comatose patients who died than in those who awoke, 51 and a third study indicated that an increase of global cerebral blood flow between 1 and 3 days and a decrease in total cerebral blood flow between 14 and 42 days postinjury were correlated with unfavorable 3-month Glasgow Outcome Scale score. 47 Two studies evaluated the predictive value of functional connectivity in comatose patients after cardiac arrest.…”

Section: Systematic Review Population Characteristicsmentioning

confidence: 99%

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Resting brain activity in disorders of consciousness

et al. 2015

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Objective: To quantitatively synthesize results from neuroimaging studies that evaluated patterns of resting functional activity in patients with disorders of consciousness (DOC).Methods: We performed a systematic review and coordinate-based meta-analysis of studies published up to May 2014. Studies were included if they compared resting-state functional neuroimaging data acquired in patients with DOC (coma, minimally conscious state, emergence from minimally conscious state, or vegetative state) with a group of healthy controls. Coordinate-based meta-analysis was performed in studies that included voxel-based comparisons at the whole-brain level and if analysis was accomplished with data-driven approaches.Results: A total of 36 studies (687 patients, 637 healthy controls) were included in the systematic review. Reported DOC were vegetative state (43.2%), coma (23.4%), minimally conscious state (22.8%), and emergence from minimally conscious state (1.6%); the most common etiologies of DOC were traumatic brain injury (37.7%) and anoxic brain injury (36.9%). Functional neuroimaging was accomplished using fMRI (16 studies), PET (15 studies), SPECT (4 studies), and both PET and SPECT in one study. Meta-analysis in 13 studies (272 patients, 259 healthy controls) revealed consistently reduced activity in patients with DOC in bilateral medial dorsal nucleus of the thalamus, left cingulate, posterior cingulate, precuneus, and middle frontal and medial temporal gyri. Conclusions:In patients with DOC evaluated in the resting state, functional neuroimaging indicates markedly reduced activity within midline cortical and subcortical sites, anatomical structures that have been linked to the default-mode network. Studies are needed to determine the relation between activation (and coherence) within these structures and the emergence of conscious awareness. Neurology ® 2015;84:1272-1280 GLOSSARY ALE 5 activation likelihood estimate; ALFF 5 amplitude of low-frequency fluctuations; BOLD 5 blood oxygen level-dependent; CRS-R 5 Coma Recovery Scale-Revised; DMN 5 default mode network; DOC 5 disorders of consciousness; EMCS 5 emergence from minimally conscious state; FDG 5 fluorodeoxyglucose; HC 5 healthy control; ICA 5 independent component analysis; MCS 5 minimally conscious state; MNI 5 Montreal Neurological Institute; PCC 5 posterior cingulate cortex; ReHo 5 regional homogeneity; ROI 5 region of interest; TBI 5 traumatic brain injury; VS 5 vegetative state.Coma is a cardinal sign of brain injury resulting from trauma, stroke, cardiac arrest, infection, or metabolic causes. While coma is a transient state from which the majority of subjects awaken, a subset of patients develop a more prolonged impairment in consciousness, such as the vegetative state (VS) or minimally conscious state (MCS). Despite considerable research, states such as coma, VS, and MCS-collectively termed disorders of consciousness (DOC)-remain poorly understood regarding their neural basis, clinical recognition, and long-term outcome.1,2 Neurophysiologic...

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Section: Systematic Review Population Characteristicsmentioning

confidence: 99%

Section: Systematic Review Population Characteristicsmentioning

confidence: 99%

Section: Systematic Review Population Characteristicsmentioning

confidence: 99%

Section: Systematic Review Population Characteristicsmentioning

confidence: 99%

Section: Systematic Review Population Characteristicsmentioning

confidence: 99%

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Resting brain activity in disorders of consciousness

et al. 2015

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Intact Brain Network Function in an Unresponsive Patient with COVID‐19

Fischer

Threlkeld

Bodien

et al. 2020

Annals of Neurology

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Many patients with severe coronavirus disease 2019 (COVID-19) remain unresponsive after surviving critical illness. Although several structural brain abnormalities have been described, their impact on brain function and implications for prognosis are unknown. Functional neuroimaging, which has prognostic significance, has yet to be explored in this population. Here we describe a patient with severe COVID-19 who, despite prolonged unresponsiveness and structural brain abnormalities, demonstrated intact functional network connectivity, and weeks later recovered the ability to follow commands. When prognosticating for survivors of severe COVID-19, clinicians should consider that brain networks may remain functionally intact despite structural injury and prolonged unresponsiveness.

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Functional Neuroimaging as an Assessment Tool in Critically Ill Patients

Norton

Kazazian

Gofton

et al. 2022

Annals of Neurology

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ObjectiveLittle is known about residual cognitive function in the earliest stages of serious brain injury. Functional neuroimaging has yielded valuable diagnostic and prognostic information in chronic disorders of consciousness, such as the vegetative state (also termed unresponsive wakefulness syndrome). The objective of the current study was to determine if functional neuroimaging could be efficacious in the assessment of cognitive function in acute disorders of consciousness, such as coma, where decisions about the withdrawal of life‐sustaining therapies are often made.MethodsA hierarchical functional magnetic resonance imaging (fMRI) approach assessed sound perception, speech perception, language comprehension, and covert command following in 17 critically ill patients admitted to the intensive care unit (ICU).ResultsPreserved auditory function was observed in 15 patients (88%), whereas 5 (29%) also had preserved higher‐order language comprehension. Notably, one patient could willfully modulate his brain activity when instructed to do so, suggesting a level of covert conscious awareness that was entirely inconsistent with his clinical diagnosis at the time of the scan. Across patients, a positive relationship was also observed between fMRI responsivity and the level of functional recovery, such that patients with the greatest functional recovery had neural responses most similar to those observed in healthy control participants.InterpretationThese results suggest that fMRI may provide important diagnostic and prognostic information beyond standard clinical assessment in acutely unresponsive patients, which may aid discussions surrounding the continuation or removal of life‐sustaining therapies during the early post‐injury period. ANN NEUROL 2023;93:131–141

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MRI Default Mode Network Connectivity is Associated with Functional Outcome After Cardiopulmonary Arrest

Cited by 61 publications

References 39 publications

Resting brain activity in disorders of consciousness

Resting brain activity in disorders of consciousness

Intact Brain Network Function in an Unresponsive Patient with COVID‐19

Functional Neuroimaging as an Assessment Tool in Critically Ill Patients

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