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A human brain network derived from coma-causing brainstem lesions.

David B Fischer1, Aaron D Boes2, Athena Demertzi2

  • 1From the Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology (D.B.F., A.D.B., A.P.-L., M.D.F.), and Department of Neurology (C.B.S., A.P.-L., M.D.F., J.C.G.), Harvard Medical School and Beth Israel Deaconess Medical Center, Boston; Harvard Medical School (D.B.F.), Boston; Departments of Pediatric Neurology (A.D.B.) and Neurology (B.L.E.), Harvard Medical School and Massachusetts General Hospital, Boston, MA; Brain and Spine Institute (Institut du Cerveau et de la Moelle épinière-ICM) (A.D.), Hôpital Pitié-Salpêtrière, Paris, France; Coma Science Group (A.D., S.L.), GIGA-Research & Cyclotron Research Centre, University and University Hospital of Liège, Belgium; Functional and Comparative Neuroanatomy Lab (H.C.E.), Centre for Integrative Neuroscience, Tübingen; Max Planck Institute for Biological Cybernetics (H.C.E.), Tübingen, Germany; Athinoula A. Martinos Center for Biomedical Imaging (B.L.E., H.L., M.D.F.), Massachusetts General Hospital, Charlestown, MA. d.b.fisch@gmail.com foxmdphd@gmail.com.

Neurology
|November 6, 2016
PubMed

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Summary
This summary is machine-generated.

A specific brainstem lesion site is linked to coma. This area connects to the ventral anterior insula (AI) and pregenual anterior cingulate cortex (pACC), crucial for maintaining consciousness and disrupted in disorders of consciousness.

Area of Science:

  • Neuroscience
  • Neurology
  • Brain Connectivity

Background:

  • Coma results from brain dysfunction, but specific lesion locations and their associated functional networks remain incompletely understood.
  • The pontine tegmentum plays a critical role in arousal and consciousness, yet its precise contribution to coma pathogenesis requires further elucidation.

Purpose of the Study:

  • To pinpoint a specific brainstem lesion location consistently associated with coma.
  • To delineate the functional connectivity network of this identified brainstem site.
  • To investigate the role of this network in disorders of consciousness.

Main Methods:

  • Voxel-based lesion-symptom mapping was employed to compare coma-causing brainstem lesions with control lesions in a case-control design.
  • Resting-state functional connectivity analysis in healthy adults identified networks connected to the critical brainstem site.

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  • Cortical network topography was compared to known networks, and functional connectivity was assessed in patients with disorders of consciousness.

    • Main Results:

    • A distinct region in the rostral dorsolateral pontine tegmentum was significantly associated with coma-inducing lesions.
    • This brainstem site showed functional connectivity with the ventral anterior insula (AI) and pregenual anterior cingulate cortex (pACC) in healthy individuals.
    • Connectivity between the AI and pACC was significantly disrupted in patients with disorders of consciousness, more so than other brain networks.

    Conclusions:

    • Lesions in a specific pontine tegmentum region are strongly linked to the development of coma.
    • The identified brainstem site connects to the AI and pACC, forming a network critical for consciousness.
    • Disruption of this AI-pACC network is implicated in disorders of consciousness, highlighting its role in maintaining human awareness.