Progression from Vegetative to Minimally Conscious State Is Associated with Changes in Brain Neural Response to Passive Tasks: A Longitudinal Single-Case Functional MRI Study

Objectives: Functional magnetic resonance imaging (fMRI) may be adopted as a complementary tool for bedside observation in the disorders of consciousness (DOC). However, the diagnostic value of this technique is still debated because of the lack of accuracy in determining levels of consciousness within a single patient. Recently, Giacino and colleagues (2014) hypothesized that a longitudinal fMRI evaluation may provide a more informative assessment in the detection of residual awareness. The aim of this study was to measure the correspondence between clinically defined level of awareness and neural responses within a single DOC patient. Methods: We used a follow-up fMRI design in combination with a passive speech-processing task. Patient\u27s consciousness was measured through time by using the Coma Recovery Scale. Results: The patient progressed from a vegetative state (VS) to a minimally conscious state (MCS). Patient\u27s task-related neural responses mirrored the clinical change from a VS to an MCS. Specifically, while in an MCS, but not a VS, the patient showed a selective recruitment of the left angular gyrus when he listened to a native speech narrative, as compared to the reverse presentation of the same stimulus. Furthermore, the patient showed an increased response in the language-related brain network and a greater deactivation in the default mode network following his progression to an MCS. Conclusions: Our findings indicate that longitudinal assessment of brain responses to passive stimuli can contribute to the definition of the clinical status in individual patients with DOC and represents an adequate counterpart of the bedside assessment during the diagnostic decision-making process. (JINS, 2016, 22, 620-630

Selective visual neglect in right brain damaged patients with splenial interhemispheric disconnection

Left unilateral neglect is frequently reported after right hemispheric lesions of the middle cerebral artery (MCA) damaging the parietal-frontal cortical-subcortical network subserving space representation and awareness. However, accumulating evidence shows that neglect can also follow lesions of the posterior cerebral artery (PCA) that do not directly affect this parietal-frontal network. Surgical studies in the monkeys have demonstrated that complete callosal resection combined with lesion of the right optic tract entirely deprives the right hemisphere of visual inputs from the left hemispace provoking severe left unilateral neglect. Here, through the detailed study of two patients we show, for the first time, that PCA lesions selectively affecting the splenium of the corpus callosum and the adjacent right primary visual cortex provoke severe neglect selectively restricted to the visual domain. No trace of personal, motor or representational-imagery neglect was found. Also at variance with previous case studies in which neglect followed lesion of the trunk or the genu of the corpus callosum, no restriction of neglect to tasks performed with the right hand, no left hemispatial limb akinesia, no tactile extinction for the left hand and no tactile anomia for stimuli explored with the left hand were observed. These findings demonstrate that brain lesions depriving intact parietal and frontal attentional areas from specific sensory inputs can yield spatial neglect limited to specific sensory modalities or sectors of space

A Voxel-Based Assessment of Noise Properties in Computed Tomography Imaging with the ASiR-V and ASiR Iterative Reconstruction Algorithms

Given the inherent characteristics of nonlinearity and nonstationarity of iterative reconstruction algorithms in computed tomography (CT) imaging, this study aimed to perform, for the first time, a voxel-based characterization of noise properties in CT imaging with the ASiR-V and ASiR algorithms as compared with conventional filtered back projection (FBP). Multiple repeated scans of the Catphan-504 phantom were carried out. CT images were reconstructed using FBP and ASiR/ASiR-V with different blending levels of reconstruction (20%, 40%, 60%, 80%, 100%). Noise maps and their nonuniformity index (NUI) were obtained according to the approach proposed by the report of AAPM TG-233. For the homogeneous CTP486 module, ASiR-V/ASiR allowed a noise reduction of up to 63.7%/52.9% relative to FBP. While the noise reduction values of ASiR-V-/ASiR-reconstructed images ranged up to 33.8%/39.9% and 31.2%/35.5% for air and Teflon contrast objects, respectively, these values were approximately 60%/50% for other contrast objects (PMP, LDPE, polystyrene, acrylic, Delrin). Moreover, for all contrast objects but air and Teflon, ASiR-V showed a greater noise reduction potential than ASiR when the blending level was ≥40%. While noise maps of the homogenous CTP486 module showed only a slight spatial variation of noise (NUI < 5.2%) for all reconstruction algorithms, the NUI values of iterative-reconstructed images of the nonhomogeneous CTP404 module increased nonlinearly with blending level and were 19%/15% and 6.7% for pure ASiR-V/ASiR and FBP, respectively. Overall, these results confirm the potential of ASiR-V and ASiR in reducing noise as compared with conventional FBP, suggesting, however, that the use of pure ASiR-V or ASiR might be suboptimal for specific clinical applications