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Prediction of recovery from post-traumatic vegetative state with cerebral magnetic-resonance imaging
A Kampfl1, E Schmutzhard, G Franz
1Department of Neurology, University Hospital Innsbruck, Austria.
Background:
The early post-traumatic vegetative state (VS) is compatible with recovery. Various clinical and laboratory tests have failed to predict recovery so we assessed the value of cerebral magnetic-resonance imaging (MRI) in prediction of recovery.
Methods:
80 adult patients in post-traumatic VS had cerebral MRI between 6 weeks and 8 weeks after injury. MRIs were reviewed by three neuroradiologists for the number, sizes, and location of brain lesions. Three neurologists assessed the patients at the time of MRI and at 2 months, 3 months, 6 months, 9 months, and 12 months after injury using the Glasgow Outcome Scale.
Findings:
At 12 months, 38 patients had recovered while 42 patients remained in the VS. The demographic characteristics and causes and severity of injury were similar in patients in persistent VS (PVS) and those who recovered (NPVS). An average of 6.1 different brain areas were injured in patients in PVS compared with 4.6 areas in patients who had NPVS. Patients in PVS revealed a significantly higher frequency of corpus callosum, corona radiata, and dorsolateral brainstem injuries than did patients who recovered. Logistic regression analysis showed that corpus callosum and dorsolateral brainstem injuries were predictive of non-recovery. The adjusted odds ratios for non-recovery of patients with a corpus callosum lesion and dorsolateral brainstem injury were 213.8 (95% CI 14.2-3213.3), and 6.9 (11-42.9), respectively. In contrast, clinical characteristics, such as initial score on the Glasgow Coma Scale, age, and pupillary abnormalities failed to predict recovery.
Interpretation:
Cerebral MRI findings in the subacute stage after head injury can predict the outcome of the post-traumatic VS. Corpus callosum and dorsolateral brainstem lesions are highly significant in predicting non-recovery.
Insights
Cerebral MRI in the subacute stage after head injury can predict recovery from a post-traumatic vegetative state (VS). Lesions in the corpus callosum and dorsolateral brainstem are highly significant indicators of non-recovery.
Area of Science:
- Neurology
- Radiology
- Neuroscience
Background:
- The early post-traumatic vegetative state (VS) can be associated with patient recovery.
- Predicting recovery from VS using clinical and laboratory tests has proven challenging.
- Cerebral magnetic-resonance imaging (MRI) was assessed for its predictive value in VS recovery.
Purpose of the Study:
- To evaluate the utility of cerebral MRI in predicting recovery from post-traumatic vegetative state.
- To identify specific MRI-detectable brain lesions associated with non-recovery.
Main Methods:
- 80 adult patients in a post-traumatic vegetative state underwent cerebral MRI between 6 and 8 weeks post-injury.
- Neuroradiologists reviewed MRIs for lesion characteristics (number, size, location).
- Neurologists assessed patient outcomes using the Glasgow Outcome Scale at multiple time points up to 12 months post-injury.
Main Results:
- Of 80 patients, 38 recovered and 42 remained in VS at 12 months.
- Patients with persistent VS had more injured brain areas on average (6.1 vs. 4.6).
- Corpus callosum and dorsolateral brainstem lesions were significantly more frequent in patients with persistent VS and were predictive of non-recovery.
Conclusions:
- Cerebral MRI findings in the subacute stage after head injury can predict the outcome of post-traumatic vegetative state.
- Specific lesions, particularly in the corpus callosum and dorsolateral brainstem, are highly significant predictors of non-recovery.