Functional magnetic resonance imaging under anaesthesia of a patient with severe chronic disorders of consciousness

We report on a 19-year old male patient who is recovering from near-drowning. The patient was admitted for re-evaluation in a Minimally Conscious State.

A regular functional Magnetic Resonance Imaging was not possible due to complex motor tics of the patient with sudden flexion and extension movements of arms and legs as well as opisthotonic retroflexion of the head and trunk. Thus, the patient was anaesthetised and functional Magnetic Resonance Imaging was performed under general anaesthesia which was introduced and maintained with Sevoflorane and Fentanyl provided analgesia. Four functional runs were performed and the patient's responses were recorded. During each one of these runs one extremity (dorsum manus or pedis) was stimulated with a brush with an operator-paced frequency of about 2 Hz.

Clear responses were found in the somatosensory cortex contra lateral within the post central gyrus during stimulation of the left hand. Considering the other three extremities no significant responses were found. Nevertheless, we conclude that a functional Magnetic Resonance Imaging under anaesthesia is possible for patients with severe chronic disorders of consciousness and brain areas responding to stimuli can be detected.