scholarly journals Cortical Function in Acute Severe Traumatic Brain Injury and at Recovery: A Longitudinal fMRI Case Study

2020 ◽  
Vol 10 (9) ◽  
pp. 604
Author(s):  
Karnig Kazazian ◽  
Loretta Norton ◽  
Teneille E. Gofton ◽  
Derek Debicki ◽  
Adrian M. Owen
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Speech Perception ◽  
Severe Traumatic Brain Injury ◽  
Resting State ◽  
Cortical Function ◽  
Sound Perception ◽  
Command Following ◽  
Resting State Connectivity ◽  
Recovery Of Consciousness

Differences in the functional integrity of the brain from acute severe brain injury to subsequent recovery of consciousness have not been well documented. Functional magnetic resonance imaging (fMRI) may elucidate this issue as it allows for the objective measurement of brain function both at rest and in response to stimuli. Here, we report the cortical function of a patient with a severe traumatic brain injury (TBI) in a critically ill state and at subsequent functional recovery 9-months post injury. A series of fMRI paradigms were employed to assess sound and speech perception, command following, and resting state connectivity. The patient retained sound perception and speech perception acutely, as indexed by his fMRI responses. Command following was absent acutely, but was present at recovery. Increases in functional connectivity across multiple resting state networks were observed at recovery. We demonstrate the clinical utility of fMRI in assessing cortical function in a patient with severe TBI. We suggest that hallmarks of the recovery of consciousness are associated with neural activity to higher-order cognitive tasks and increased resting state connectivity.

scholarly journals Agitation Following Severe Traumatic Brain Injury Is a Clinical Sign of Recovery of Consciousness

2021 ◽  
Vol 8 ◽  
Author(s):  
Zhe Wang ◽  
Nathan J. Winans ◽  
Zirun Zhao ◽  
Megan E. Cosgrove ◽  
Theresa Gammel ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Retrospective Chart Review ◽  
University Hospital ◽  
Clinical Notes ◽  
Violent Behaviors ◽  
Neurological Functioning ◽  
Command Following ◽  
Recovery Of Consciousness

Objective: Severe traumatic brain injury (sTBI) often results in disorders of consciousness. Patients emerging from coma frequently exhibit aberrant behaviors such as agitation. These non-purposeful combative behaviors can interfere with medical care. Interestingly, agitation is associated with arousal and is often among the first signs of neurological recovery. A better understanding of these behaviors may shed light on the mechanisms driving the return of consciousness in sTBI patients. This study aims to investigate the association between posttraumatic agitation and the recovery of consciousness.Methods: A retrospective chart review was conducted in 530 adult patients (29.1% female) admitted to Stony Brook University Hospital between January 2011 and December 2019 with a diagnosis of sTBI and Glasgow Coma Scale (GCS) ≤8. Agitation was defined as a Richmond Agitation Sedation Scale (RASS) > +1, or any documentation of equivalently combative and violent behaviors in daily clinical notes. The ability to follow verbal commands was used to define the recovery of consciousness and was assessed daily.Results: Of 530 total sTBI patients, 308 (58.1%) survived. Agitation was present in 169 of all patients and 162 (52.6%) of surviving patients. A total of 273 patients followed commands, and 159 of them developed agitation. Forty patients developed agitation on hospital arrival whereas 119 developed agitation later during their hospital course. Presence of in-hospital agitation positively correlated with command-following (r = 0.315, p < 0.001). The time to develop agitation and time to follow commands showed positive correlation (r = 0.485, p < 0.001). These two events occurred within 3 days in 54 (44.6%) patients, within 7 days in 81 (67.8%) patients, and within 14 days in 96 (80.2%) patients. In 71 (59.7%) patients, agitation developed before command-following; in 36 (30.2%) patients, agitation developed after command-following; in 12 (10.1%) patients, agitation developed on the same day as command-following.Conclusion: Posttraumatic agitation in comatose patients following sTBI is temporally associated with the recovery of consciousness. This behavior indicates the potential for recovery of higher neurological functioning. Further studies are required to identify neural correlates of posttraumatic agitation and recovery of consciousness after sTBI.

Functional Wavelet Connectivity in Resting State Reflects Consciousness Recovery in Patients with Severe Traumatic Brain Injury

2021 ◽  
Vol 47 (2) ◽  
pp. 128-136
Author(s):  
A. S. Zigmantovich ◽  
L. B. Oknina ◽  
M. M. Kopachka ◽  
E. L. Masherow ◽  
E. V. Alexandrova
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Resting State

scholarly journals Electrophysiological correlates of thalamocortical function in acute severe traumatic brain injury

2021 ◽  
Author(s):  
William H. Curley ◽  
Yelena G. Bodien ◽  
David W. Zhou ◽  
Mary M. Conte ◽  
Andrea S. Foulkes ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Resting State ◽  
Chronic Phase ◽  
Post Injury ◽  
Network Function ◽  
Power Spectral ◽  
Level Of Consciousness ◽  
Thalamocortical Network

Few reliable biomarkers of consciousness exist for patients with acute severe brain injury. Tools assaying the neural networks that modulate consciousness may allow for tracking of recovery. The mesocircuit model, and its instantiation as the ABCD framework, classifies resting-state EEG power spectral densities into categories reflecting widely separated levels of thalamocortical network function and correlates with outcome in post-cardiac arrest coma. We applied the ABCD framework to acute severe traumatic brain injury and tested four hypotheses: 1) EEG channel-level ABCD classifications are spatially heterogeneous and temporally variable; 2) ABCD classifications improve longitudinally, commensurate with the degree of behavioural recovery; 3) ABCD classifications correlate with behavioural level of consciousness; and 4) the Coma Recovery Scale-Revised arousal facilitation protocol improves EEG dynamics along the ABCD scale. In this longitudinal cohort study, we enrolled 20 patients with acute severe traumatic brain injury requiring intensive care and 16 healthy controls. Through visual inspection, channel-level spectra from resting-state EEG were classified based on spectral peaks within frequency bands defined by the ABCD framework: A = no peaks above delta (<4 Hz) range (complete thalamocortical disruption); B = theta (4-8 Hz) peak (severe thalamocortical disruption); C = theta and beta (13-24 Hz) peaks (moderate thalamocortical disruption); or D = alpha (8-13 Hz) and beta peaks (normal thalamocortical function). We assessed behavioural level of consciousness with the Coma Recovery Scale-Revised or neurological examination and, in 12 patients, performed repeat EEG and behavioural assessments at ≥6-months post-injury. Acutely, 95% of patients demonstrated D signals in at least one channel but exhibited heterogeneity in the proportion of different channel-level ABCD classifications (mean percent D signals: 37%, range: 0-90%). By contrast, healthy participants and patients at follow-up predominantly demonstrated signals corresponding to intact thalamocortical network function (mean percent D signals: 94%). In patients studied acutely, ABCD classifications improved after the Coma Recovery Scale-Revised arousal facilitation protocol (P<0.05), providing electrophysiological evidence for the effectiveness of this commonly performed technique. ABCD classification did not correspond with behavioural level of consciousness acutely, where patients demonstrated substantial within-session temporal variability in ABCD classifications. However, ABCD classification distinguished patients with and without command-following in the subacute-to-chronic phase of recovery (P<0.01). Patients also demonstrated significant longitudinal improvement in EEG dynamics along the ABCD scale (median change in D signals: 37%, P<0.05). These findings support the use of the ABCD framework to characterize channel-level EEG dynamics and track fluctuations in functional thalamocortical network integrity in spatial detail.

scholarly journals fMRI resting state networks visualization in patients with severe traumatic brain injury

2020 ◽  
Vol 24 (1) ◽  
pp. 68-84
Author(s):  
E. V. Sharova ◽  
Ju. V. Kotovich ◽  
Yacila Isabela Deza-Araujo ◽  
A. S. Smirnov ◽  
A. A. Gavron ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Resting State ◽  
Resting State Networks

Location of Subcortical Microbleeds and Recovery of Consciousness After Severe Traumatic Brain Injury

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012192
Author(s):  
Marta Bianciardi ◽  
Saef Izzy ◽  
Bruce Rosen ◽  
Lawrence L. Wald ◽  
Brian L. Edlow
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Basal Forebrain ◽  
Mesencephalic Reticular Formation ◽  
Brainstem Nucleus ◽  
Severe Tbi ◽  
Mesopontine Tegmentum ◽  
Recovery Of Consciousness ◽  
Nucleus Volume

Background:In patients with severe traumatic brain injury (TBI), coma is associated with impaired subcortical arousal mechanisms. However, it is unknown which nuclei involved in arousal (“arousal nuclei”) are implicated in coma pathogenesis and are compatible with coma recovery.Methods:We mapped an atlas of arousal nuclei in the brainstem, thalamus, hypothalamus, and basal forebrain onto 3 Tesla susceptibility-weighted images (SWI) in twelve patients with acute severe TBI who presented in coma and recovered consciousness within six months. We assessed the spatial distribution and volume of SWI microbleeds and evaluated the association of microbleed volume with the duration of unresponsiveness and functional recovery at six months.Results:There was no single arousal nucleus affected by microbleeds in all patients. Rather, multiple combinations of microbleeds in brainstem, thalamic, and hypothalamic arousal nuclei were associated with coma and were compatible with recovery of consciousness. Microbleeds were frequently detected in the midbrain (100%), thalamus (83%) and pons (75%). Within the brainstem, the microbleed incidence was largest within the mesopontine tegmentum (e.g., pedunculotegmental nucleus, mesencephalic reticular formation) and ventral midbrain (e.g., substantia nigra, ventral tegmental area). Brainstem arousal nuclei were partially affected by microbleeds, with microbleed volume not exceeding 35% of brainstem nucleus volume on average. Compared to microbleed volume within non-arousal brainstem regions, the microbleed volume within arousal brainstem nuclei accounted for a larger proportion of variance in the duration of unresponsiveness and 6-month Glasgow Outcome Scale-Extended scores.Conclusions:These results suggest resilience of arousal mechanisms in the human brain after severe TBI.

scholarly journals Functional networks reemerge during recovery of consciousness after acute severe traumatic brain injury

Cortex ◽  
2018 ◽  
Vol 106 ◽  
pp. 299-308 ◽  
Author(s):  
Zachary D. Threlkeld ◽  
Yelena G. Bodien ◽  
Eric S. Rosenthal ◽  
Joseph T. Giacino ◽  
Alfonso Nieto-Castanon ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Functional Networks ◽  
Recovery Of Consciousness

Detection of Covert Command-Following and Communication in a Patient with Severe Traumatic Brain Injury

2014 ◽  
Vol 95 (10) ◽  
pp. e78
Author(s):  
Yelena Guller ◽  
Hong Pan ◽  
Swathi Iyer ◽  
Lorene Leung ◽  
Rachel Cohn ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Command Following
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