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Snider SB, Temkin NR, Sun X, Stubbs JL, Rademaker QJ, Markowitz AJ, Rosenthal ES, Diaz-Arrastia R, Fox MD, Manley GT, Jain S, Edlow BL. Automated Measurement of Cerebral Hemorrhagic Contusions and Outcomes After Traumatic Brain Injury in the TRACK-TBI Study. JAMA Netw Open 2024; 7:e2427772. [PMID: 39212991 PMCID: PMC11365003 DOI: 10.1001/jamanetworkopen.2024.27772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 06/18/2024] [Indexed: 09/04/2024] Open
Abstract
Importance Because withdrawal of life-sustaining therapy based on perceived poor prognosis is the most common cause of death after moderate or severe traumatic brain injury (TBI), the accuracy of clinical prognoses is directly associated with mortality. Although the location of brain injury is known to be important for determining recovery potential after TBI, the best available prognostic models, such as the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) score, do not currently incorporate brain injury location. Objective To test whether automated measurement of cerebral hemorrhagic contusion size and location is associated with improved prognostic performance of the IMPACT score. Design, Setting, and Participants This prognostic cohort study was performed in 18 US level 1 trauma centers between February 26, 2014, and August 8, 2018. Adult participants aged 17 years or older from the US-based Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study with moderate or severe TBI (Glasgow Coma Scale score 3-12) and contusions detected on brain computed tomography (CT) scans were included. The data analysis was performed between January 2023 and February 2024. Exposures Labeled contusions detected on CT scans using Brain Lesion Analysis and Segmentation Tool for Computed Tomography (BLAST-CT), a validated artificial intelligence algorithm. Main Outcome and Measure The primary outcome was a Glasgow Outcome Scale-Extended (GOSE) score of 4 or less at 6 months after injury. Whether frontal or temporal lobe contusion volumes improved the performance of the IMPACT score was tested using logistic regression and area under the receiver operating characteristic curve comparisons. Sparse canonical correlation analysis was used to generate a disability heat map to visualize the strongest brainwide associations with outcomes. Results The cohort included 291 patients with moderate or severe TBI and contusions (mean [SD] age, 42 [18] years; 221 [76%] male; median [IQR] emergency department arrival Glasgow Coma Scale score, 5 [3-10]). Only temporal contusion volumes improved the discrimination of the IMPACT score (area under the receiver operating characteristic curve, 0.86 vs 0.84; P = .03). The data-derived disability heat map of contusion locations showed that the strongest association with unfavorable outcomes was within the bilateral temporal and medial frontal lobes. Conclusions and Relevance These findings suggest that CT-based automated contusion measurement may be an immediately translatable strategy for improving TBI prognostic models.
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Affiliation(s)
- Samuel B. Snider
- Division of Neurocritical Care, Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Nancy R. Temkin
- Department of Neurological Surgery, University of Washington, Seattle
- Department of Biostatistics, University of Washington, Seattle
| | - Xiaoying Sun
- Biostatistics Research Center, Herbert Wertheim School of Public Health, University of California, San Diego
| | - Jacob L. Stubbs
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Quinn J. Rademaker
- Division of Neurocritical Care, Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Amy J. Markowitz
- Department of Neurological Surgery, University of California, San Francisco
| | - Eric S. Rosenthal
- Harvard Medical School, Boston, Massachusetts
- Division of Clinical Neurophysiology, Department of Neurology, Massachusetts General Hospital, Boston
| | | | - Michael D. Fox
- Harvard Medical School, Boston, Massachusetts
- Center for Brain Circuit Therapeutics, Departments of Neurology, Psychiatry, and Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown
| | - Geoffrey T. Manley
- Department of Neurological Surgery, University of California, San Francisco
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Sonia Jain
- Biostatistics Research Center, Herbert Wertheim School of Public Health, University of California, San Diego
| | - Brian L. Edlow
- Harvard Medical School, Boston, Massachusetts
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston
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Whyte CJ, Redinbaugh MJ, Shine JM, Saalmann YB. Thalamic contributions to the state and contents of consciousness. Neuron 2024; 112:1611-1625. [PMID: 38754373 DOI: 10.1016/j.neuron.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/11/2024] [Accepted: 04/17/2024] [Indexed: 05/18/2024]
Abstract
Consciousness can be conceptualized as varying along at least two dimensions: the global state of consciousness and the content of conscious experience. Here, we highlight the cellular and systems-level contributions of the thalamus to conscious state and then argue for thalamic contributions to conscious content, including the integrated, segregated, and continuous nature of our experience. We underscore vital, yet distinct roles for core- and matrix-type thalamic neurons. Through reciprocal interactions with deep-layer cortical neurons, matrix neurons support wakefulness and determine perceptual thresholds, whereas the cortical interactions of core neurons maintain content and enable perceptual constancy. We further propose that conscious integration, segregation, and continuity depend on the convergent nature of corticothalamic projections enabling dimensionality reduction, a thalamic reticular nucleus-mediated divisive normalization-like process, and sustained coherent activity in thalamocortical loops, respectively. Overall, we conclude that the thalamus plays a central topological role in brain structures controlling conscious experience.
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Affiliation(s)
- Christopher J Whyte
- Centre for Complex Systems, The University of Sydney, Sydney, NSW, Australia; Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | | | - James M Shine
- Centre for Complex Systems, The University of Sydney, Sydney, NSW, Australia; Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Yuri B Saalmann
- Department of Psychology, University of Wisconsin - Madison, Madison, WI, USA; Wisconsin National Primate Research Center, Madison, WI, USA
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Arciniegas DB, Gurin LJ, Zhang B. Structural and Functional Neuroanatomy of Core Consciousness: A Primer for Disorders of Consciousness Clinicians. Phys Med Rehabil Clin N Am 2024; 35:35-50. [PMID: 37993192 DOI: 10.1016/j.pmr.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Understanding the structural and functional neuroanatomy of core consciousness (ie, wakefulness and awareness) is an asset to clinicians caring for persons with disorders of consciousness. This article provides a primer on the structural and functional neuroanatomy of wakefulness and awareness. The neuroanatomical structures supporting these elements of core consciousness functions are reviewed first, after which brief description of the clinically evaluable relationships between disruption of these structures and disorders of consciousness (ie, brain-behavior relationships) are outlined. Consideration of neuroanatomy at the mesoscale (ie, the mesocircuit hypothesis) as well as in relation to several large-scale neural networks is offered.
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Affiliation(s)
- David B Arciniegas
- Marcus Institute for Brain Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Department of Neurology, University of Colorado School of Medicine, Aurora, CO 80045, USA; Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO 80045, USA; Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA.
| | - Lindsey J Gurin
- Department of Neurology, NYU Grossman School of Medicine, New York, NY 10017, USA; Department of Psychiatry, NYU Grossman School of Medicine, New York, NY 10016, USA; Department of Physical Medicine & Rehabilitation, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Bei Zhang
- Division of Physical Medicine and Rehabilitation, Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
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4
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Aru J, Larkum ME, Shine JM. The feasibility of artificial consciousness through the lens of neuroscience. Trends Neurosci 2023; 46:1008-1017. [PMID: 37863713 DOI: 10.1016/j.tins.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/23/2023] [Accepted: 09/27/2023] [Indexed: 10/22/2023]
Abstract
Interactions with large language models (LLMs) have led to the suggestion that these models may soon be conscious. From the perspective of neuroscience, this position is difficult to defend. For one, the inputs to LLMs lack the embodied, embedded information content characteristic of our sensory contact with the world around us. Secondly, the architectures of present-day artificial intelligence algorithms are missing key features of the thalamocortical system that have been linked to conscious awareness in mammals. Finally, the evolutionary and developmental trajectories that led to the emergence of living conscious organisms arguably have no parallels in artificial systems as envisioned today. The existence of living organisms depends on their actions and their survival is intricately linked to multi-level cellular, inter-cellular, and organismal processes culminating in agency and consciousness.
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Affiliation(s)
- Jaan Aru
- Institute of Computer Science, University of Tartu, Tartu, Estonia.
| | - Matthew E Larkum
- Institute of Biology, Humboldt University Berlin, Berlin, Germany.
| | - James M Shine
- Brain and Mind Center, The University of Sydney, Sydney, Australia.
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Liaw YS, Augustine GJ. The claustrum and consciousness: An update. Int J Clin Health Psychol 2023; 23:100405. [PMID: 37701759 PMCID: PMC10493512 DOI: 10.1016/j.ijchp.2023.100405] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/10/2023] [Indexed: 09/14/2023] Open
Abstract
The seminal paper of Crick and Koch (2005) proposed that the claustrum, an enigmatic and thin grey matter structure that lies beside the insular cortex, may be involved in the processing of consciousness. As a result, this otherwise obscure structure has received ever-increasing interest in the search for neural correlates of consciousness. Here we review theories of consciousness and discuss the possible relationship between the claustrum and consciousness. We review relevant experimental evidence collected since the Crick and Koch (2005) paper and consider whether these findings support or contradict their hypothesis. We also explore how future experimental work can be designed to clarify how consciousness emerges from neural activity and to understand the role of the claustrum in consciousness.
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Affiliation(s)
- Yin Siang Liaw
- Neuroscience & Mental Health Program, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - George J. Augustine
- Neuroscience & Mental Health Program, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Alnagger N, Cardone P, Martial C, Laureys S, Annen J, Gosseries O. The current and future contribution of neuroimaging to the understanding of disorders of consciousness. Presse Med 2023; 52:104163. [PMID: 36796250 DOI: 10.1016/j.lpm.2022.104163] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 11/21/2022] [Accepted: 12/13/2022] [Indexed: 02/16/2023] Open
Abstract
Patients with disorders of consciousness (DoC) represent a group of severely brain-injured patients with varying capacities for consciousness in terms of both wakefulness and awareness. The current state-of-the-art for assessing these patients is through standardised behavioural examinations, but inaccuracies are commonplace. Neuroimaging and electrophysiological techniques have revealed vast insights into the relationships between neural alterations, andcognitive and behavioural features of consciousness in patients with DoC. This has led to the establishment of neuroimaging paradigms for the clinical assessment of DoC patients. Here, we review selected neuroimaging findings on the DoC population, outlining key findings of the dysfunction underlying DoC and presenting the current clinical utility of neuroimaging tools. We discuss that whilst individual brain areas play instrumental roles in generating and supporting consciousness, activation of these areas alone is not sufficient for conscious experience. Instead, for consciousness to arise, we need preserved thalamo-cortical circuits, in addition to sufficient connectivity between distinctly differentiated brain networks, underlined by connectivity both within, and between such brain networks. Finally, we present recent advances and future perspectives in computational methodologies applied to DoC, supporting the notion that progress in the science of DoC will be driven by a symbiosis of these data-driven analyses, and theory-driven research. Both perspectives will work in tandem to provide mechanistic insights contextualised within theoretical frameworks which ultimately inform the practice of clinical neurology.
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Affiliation(s)
- Naji Alnagger
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau(2), University Hospital of Liège, Liège, Belgium
| | - Paolo Cardone
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau(2), University Hospital of Liège, Liège, Belgium
| | - Charlotte Martial
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau(2), University Hospital of Liège, Liège, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau(2), University Hospital of Liège, Liège, Belgium; CERVO Research Center, Laval University, Quebec, Canada
| | - Jitka Annen
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau(2), University Hospital of Liège, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium; Centre du Cerveau(2), University Hospital of Liège, Liège, Belgium.
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7
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Ciacciarelli A, Francalanza I, Giammello F, Galletta K, Toscano A, Musolino RF, Granata F, La Spina P. Prevalence, clinical features, and radiological pattern of artery of Percheron infarction: a challenging diagnosis. Neurol Sci 2023:10.1007/s10072-023-06681-4. [PMID: 36800102 DOI: 10.1007/s10072-023-06681-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE Occlusion of artery of Percheron (AOP), a rare variant of paramedian branches of posterior cerebral artery, results in a characteristic pattern of ischemic lesions in bilateral paramedian thalami with or without midbrain and anterior thalami involvement. AIM To evaluate the prevalence, the clinical, and the imaging features of AOP infarction in a single comprehensive stroke center experience. METHODS We retrospectively search in our stroke center database, patients with ischemic lesions in the AOP distribution. We collected clinical features and time between hospital admission and diagnosis. Imaging findings were categorized following a pre-selected classification. RESULTS Of 2830 ischemic stroke admitted in our center, we identified 15 patients with AOP infarction (0.53%). Clinical manifestations were variable, but oculomotor disturbances, particularly vertical gaze palsy, were the most observed, followed by consciousness impairment, varying from drowsiness to coma. The most frequent imaging pattern was bilateral paramedian thalamic infarction with midbrain infarction, and the V-sign was recognized in 6 cases from this group. In 8 patients a fetal origin of the PCA was observed. The average time from first hospital admission to diagnosis was 28.09 h. CONCLUSIONS The prevalence of AOP infarction in our center was 0.53%. Diagnosis of AOP infarction can be challenging and should be suspected in case of sudden altered consciousness.
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Affiliation(s)
- Antonio Ciacciarelli
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Isabella Francalanza
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Fabrizio Giammello
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
- International PhD Translational Molecular Medicine and Surgery, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy.
| | - Karol Galletta
- Neuroradiology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Antonio Toscano
- International PhD Translational Molecular Medicine and Surgery, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Rosa Fortunata Musolino
- International PhD Translational Molecular Medicine and Surgery, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Francesca Granata
- Neuroradiology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Paolino La Spina
- International PhD Translational Molecular Medicine and Surgery, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
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8
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Schnetzer L, McCoy M, Bergmann J, Kunz A, Leis S, Trinka E. Locked-in syndrome revisited. Ther Adv Neurol Disord 2023; 16:17562864231160873. [PMID: 37006459 PMCID: PMC10064471 DOI: 10.1177/17562864231160873] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/14/2023] [Indexed: 03/31/2023] Open
Abstract
The locked-in syndrome (LiS) is characterized by quadriplegia with preserved vertical eye and eyelid movements and retained cognitive abilities. Subcategorization, aetiologies and the anatomical foundation of LiS are discussed. The damage of different structures in the pons, mesencephalon and thalamus are attributed to symptoms of classical, complete and incomplete LiS and the locked-in plus syndrome, which is characterized by additional impairments of consciousness, making the clinical distinction to other chronic disorders of consciousness at times difficult. Other differential diagnoses are cognitive motor dissociation (CMD) and akinetic mutism. Treatment options are reviewed and an early, interdisciplinary and aggressive approach, including the provision of psychological support and coping strategies is favoured. The establishment of communication is a main goal of rehabilitation. Finally, the quality of life of LiS patients and ethical implications are considered. While patients with LiS report a high quality of life and well-being, medical professionals and caregivers have largely pessimistic perceptions. The negative view on life with LiS must be overthought and the autonomy and dignity of LiS patients prioritized. Knowledge has to be disseminated, diagnostics accelerated and technical support system development promoted. More well-designed research but also more awareness of the needs of LiS patients and their perception as individual persons is needed to enable a life with LiS that is worth living.
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Affiliation(s)
| | - Mark McCoy
- Department of Neurology, Neurological Intensive Care and Neurorehabilitation, Christian Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
| | - Jürgen Bergmann
- Department of Neurology, Neurological Intensive Care and Neurorehabilitation, Christian Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
| | - Alexander Kunz
- Department of Neurology, Neurological Intensive Care and Neurorehabilitation, Christian Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
- Karl Landsteiner Institute of Neurorehabilitation and Space Neurology, Salzburg, Austria
| | - Stefan Leis
- Department of Neurology, Neurological Intensive Care and Neurorehabilitation, Christian Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Neurological Intensive Care and Neurorehabilitation, Christian Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
- MRI Research Unit, Neuroscience Institute, Christian Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
- Karl Landsteiner Institute of Neurorehabilitation and Space Neurology, Salzburg, Austria
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Fischer D, Newcombe V, Fernandez-Espejo D, Snider SB. Applications of Advanced MRI to Disorders of Consciousness. Semin Neurol 2022; 42:325-334. [PMID: 35790201 DOI: 10.1055/a-1892-1894] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Disorder of consciousness (DoC) after severe brain injury presents numerous challenges to clinicians, as the diagnosis, prognosis, and management are often uncertain. Magnetic resonance imaging (MRI) has long been used to evaluate brain structure in patients with DoC. More recently, advances in MRI technology have permitted more detailed investigations of the brain's structural integrity (via diffusion MRI) and function (via functional MRI). A growing literature has begun to show that these advanced forms of MRI may improve our understanding of DoC pathophysiology, facilitate the identification of patient consciousness, and improve the accuracy of clinical prognostication. Here we review the emerging evidence for the application of advanced MRI for patients with DoC.
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Affiliation(s)
- David Fischer
- Division of Neurocritical Care, Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Virginia Newcombe
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Davinia Fernandez-Espejo
- School of Psychology and Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
| | - Samuel B Snider
- Division of Neurocritical Care, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
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Bowren M, Bruss J, Manzel K, Edwards D, Liu C, Corbetta M, Tranel D, Boes AD. Post-stroke outcomes predicted from multivariate lesion-behaviour and lesion network mapping. Brain 2022; 145:1338-1353. [PMID: 35025994 PMCID: PMC9630711 DOI: 10.1093/brain/awac010] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/10/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
Clinicians and scientists alike have long sought to predict the course and severity of chronic post-stroke cognitive and motor outcomes, as the ability to do so would inform treatment and rehabilitation strategies. However, it remains difficult to make accurate predictions about chronic post-stroke outcomes due, in large part, to high inter-individual variability in recovery and a reliance on clinical heuristics rather than empirical methods. The neuroanatomical location of a stroke is a key variable associated with long-term outcomes, and because lesion location can be derived from routinely collected clinical neuroimaging data there is an opportunity to use this information to make empirically based predictions about post-stroke deficits. For example, lesion location can be compared to statistically weighted multivariate lesion-behaviour maps of neuroanatomical regions that, when damaged, are associated with specific deficits based on aggregated outcome data from large cohorts. Here, our goal was to evaluate whether we can leverage lesion-behaviour maps based on data from two large cohorts of individuals with focal brain lesions to make predictions of 12-month cognitive and motor outcomes in an independent sample of stroke patients. Further, we evaluated whether we could augment these predictions by estimating the structural and functional networks disrupted in association with each lesion-behaviour map through the use of structural and functional lesion network mapping, which use normative structural and functional connectivity data from neurologically healthy individuals to elucidate lesion-associated networks. We derived these brain network maps using the anatomical regions with the strongest association with impairment for each cognitive and motor outcome based on lesion-behaviour map results. These peak regional findings became the 'seeds' to generate networks, an approach that offers potentially greater precision compared to previously used single-lesion approaches. Next, in an independent sample, we quantified the overlap of each lesion location with the lesion-behaviour maps and structural and functional lesion network mapping and evaluated how much variance each could explain in 12-month behavioural outcomes using a latent growth curve statistical model. We found that each lesion-deficit mapping modality was able to predict a statistically significant amount of variance in cognitive and motor outcomes. Both structural and functional lesion network maps were able to predict variance in 12-month outcomes beyond lesion-behaviour mapping. Functional lesion network mapping performed best for the prediction of language deficits, and structural lesion network mapping performed best for the prediction of motor deficits. Altogether, these results support the notion that lesion location and lesion network mapping can be combined to improve the prediction of post-stroke deficits at 12-months.
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Affiliation(s)
- Mark Bowren
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA 52242, USA
| | - Joel Bruss
- Department of Neurology, Carver College of Medicine, Iowa City, IA 52242, USA
| | - Kenneth Manzel
- Department of Neurology, Carver College of Medicine, Iowa City, IA 52242, USA
| | - Dylan Edwards
- Moss Rehabilitation Research Institute, Elkins Park, PA 19027, USA
- Edith Cowan University, Joondalup, WA 6027, Australia
| | - Charles Liu
- Neurorestoration Center and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | - Maurizio Corbetta
- Department of Neuroscience, Venetian Institute of Molecular Medicine and Padova Neuroscience Center, University of Padua, Padova, PD 32122, Italy
| | - Daniel Tranel
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA 52242, USA
- Department of Neurology, Carver College of Medicine, Iowa City, IA 52242, USA
| | - Aaron D Boes
- Departments of Neurology, Psychiatry, and Pediatrics, Carver College of Medicine, Iowa City, IA 52242, USA
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11
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Baron M, Devor M. Might pain be experienced in the brainstem rather than in the cerebral cortex? Behav Brain Res 2022; 427:113861. [DOI: 10.1016/j.bbr.2022.113861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/09/2022] [Accepted: 03/23/2022] [Indexed: 11/02/2022]
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12
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Cosgrove ME, Saadon JR, Mikell CB, Stefancin PL, Alkadaa L, Wang Z, Saluja S, Servider J, Razzaq B, Huang C, Mofakham S. Thalamo-Prefrontal Connectivity Correlates With Early Command-Following After Severe Traumatic Brain Injury. Front Neurol 2022; 13:826266. [PMID: 35250829 PMCID: PMC8895046 DOI: 10.3389/fneur.2022.826266] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/25/2022] [Indexed: 12/19/2022] Open
Abstract
Recovery of consciousness after traumatic brain injury (TBI) is heterogeneous and difficult to predict. Structures such as the thalamus and prefrontal cortex are thought to be important in facilitating consciousness. We sought to investigate whether the integrity of thalamo-prefrontal circuits, assessed via diffusion tensor imaging (DTI), was associated with the return of goal-directed behavior after severe TBI. We classified a cohort of severe TBI patients (N = 25, 20 males) into Early and Late/Never outcome groups based on their ability to follow commands within 30 days post-injury. We assessed connectivity between whole thalamus, and mediodorsal thalamus (MD), to prefrontal cortex (PFC) subregions including dorsolateral PFC (dlPFC), medial PFC (mPFC), anterior cingulate (ACC), and orbitofrontal (OFC) cortices. We found that the integrity of thalamic projections to PFC subregions (L OFC, L and R ACC, and R mPFC) was significantly associated with Early command-following. This association persisted when the analysis was restricted to prefrontal-mediodorsal (MD) thalamus connectivity. In contrast, dlPFC connectivity to thalamus was not significantly associated with command-following. Using the integrity of thalamo-prefrontal connections, we created a linear regression model that demonstrated 72% accuracy in predicting command-following after a leave-one-out analysis. Together, these data support a role for thalamo-prefrontal connectivity in the return of goal-directed behavior following TBI.
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Affiliation(s)
- Megan E. Cosgrove
- Department of Neurosurgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | - Jordan R. Saadon
- Department of Neurosurgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | - Charles B. Mikell
- Department of Neurosurgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | | | - Leor Alkadaa
- Department of Neurosurgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | - Zhe Wang
- Department of Neurosurgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | - Sabir Saluja
- Department of Neurosurgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | - John Servider
- Department of Neurosurgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | - Bayan Razzaq
- Department of Neurosurgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | - Chuan Huang
- Department of Radiology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | - Sima Mofakham
- Department of Neurosurgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
- Department of Electrical and Computer Engineering, Stony Brook University, Stony Brook, NY, United States
- *Correspondence: Sima Mofakham
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13
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Barrash J, Bruss J, Anderson SW, Kuceyeski A, Manzel K, Tranel D, Boes AD. Lesions in different prefrontal sectors are associated with different types of acquired personality disturbances. Cortex 2022; 147:169-184. [PMID: 35051710 PMCID: PMC8816872 DOI: 10.1016/j.cortex.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/13/2021] [Accepted: 12/08/2021] [Indexed: 02/03/2023]
Abstract
"Frontal lobe syndrome" is a term often used to describe a diverse array of personality disturbances following frontal lobe damage. This study's guiding premise was that greater neuroanatomical specificity could be achieved by evaluating specific types of personality disturbances following acquired frontal lobe lesions. We hypothesized that three acquired personality disturbances would be associated with lesion involvement of distinct sectors of the prefrontal cortex (PFC): 1) emotional-social disturbance and ventromedial PFC, 2) hypoemotional disturbance and dorsomedial PFC, and 3) dysexecutive and dorsolateral PFC. In addition, we hypothesized that distressed personality disturbance would not be associated with focal PFC lesions in any sector. Each hypothesis was pre-registered and tested in 182 participants with adult-onset, chronic, focal brain lesions studied with an observational, cross-sectional design. Pre- and postmorbid personality was assessed by informant-rating with the Iowa Scales of Personality Change, completed by a spouse or family member. Two complementary analytic approaches were employed: 1) a hypothesis-driven region-of-interest (ROI) regression analysis examining the associations of lesions in specific PFC sectors with acquired personality disturbances; 2) a data-driven multivariate lesion-behavior mapping analysis, which was not limited to pre-specified regions. Each hypothesis received some support: (i) Emotional/social personality disturbance was most strongly associated with ventromedial PFC lesions in both statistical approaches. (ii) Hypoemotional disturbance was associated with dorsomedial PFC lesions in the ROI analyses, without any significant lesion-symptom mapping associations. (iii) Dysexecutive personality disturbance was associated with bilateral dorsolateral PFC lesions and ventromedial PFC lesions; lesion-symptom mapping showed maximal association of executive dysfunction with damage of the right middle frontal gyrus within the dorsolateral PFC. (iv) Distressed personality disturbance was not associated with lesions in any PFC sector. Altogether, the findings can be interpreted to indicate that damage to different prefrontal sectors may disrupt different anatomical-functional systems and result in distinct personality disturbances.
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Affiliation(s)
- Joseph Barrash
- Department of Neurology, Carver College of Medicine, Iowa City, IA, United States; Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, United States.
| | - Joel Bruss
- Department of Neurology, Carver College of Medicine, Iowa City, IA, United States
| | - Steven W Anderson
- Department of Neurology, Carver College of Medicine, Iowa City, IA, United States
| | - Amy Kuceyeski
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States; Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, United States
| | - Kenneth Manzel
- Department of Neurology, Carver College of Medicine, Iowa City, IA, United States
| | - Daniel Tranel
- Department of Neurology, Carver College of Medicine, Iowa City, IA, United States; Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, United States
| | - Aaron D Boes
- Department of Neurology, Carver College of Medicine, Iowa City, IA, United States; Department of Psychiatry, Carver College of Medicine, Iowa City, IA, United States; Department of Pediatrics, Carver College of Medicine, Iowa City, IA, United States
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14
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Anand B. Stupor resolving into rapidly deteriorating locked-in syndrome: Early magnetic resonance imaging brain in diagnosis. ARCHIVES OF MENTAL HEALTH 2022. [DOI: 10.4103/amh.amh_43_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Grady FS, Boes AD, Geerling JC. A Century Searching for the Neurons Necessary for Wakefulness. Front Neurosci 2022; 16:930514. [PMID: 35928009 PMCID: PMC9344068 DOI: 10.3389/fnins.2022.930514] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/15/2022] [Indexed: 11/25/2022] Open
Abstract
Wakefulness is necessary for consciousness, and impaired wakefulness is a symptom of many diseases. The neural circuits that maintain wakefulness remain incompletely understood, as do the mechanisms of impaired consciousness in many patients. In contrast to the influential concept of a diffuse "reticular activating system," the past century of neuroscience research has identified a focal region of the upper brainstem that, when damaged, causes coma. This region contains diverse neuronal populations with different axonal projections, neurotransmitters, and genetic identities. Activating some of these populations promotes wakefulness, but it remains unclear which specific neurons are necessary for sustaining consciousness. In parallel, pharmacological evidence has indicated a role for special neurotransmitters, including hypocretin/orexin, histamine, norepinephrine, serotonin, dopamine, adenosine and acetylcholine. However, genetically targeted experiments have indicated that none of these neurotransmitters or the neurons producing them are individually necessary for maintaining wakefulness. In this review, we emphasize the need to determine the specific subset of brainstem neurons necessary for maintaining arousal. Accomplishing this will enable more precise mapping of wakefulness circuitry, which will be useful in developing therapies for patients with coma and other disorders of arousal.
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Affiliation(s)
- Fillan S Grady
- Geerling Laboratory, Department of Neurology, Iowa Neuroscience Institute, The University of Iowa, Iowa City, IA, United States
| | - Aaron D Boes
- Boes Laboratory, Departments of Pediatrics, Neurology, and Psychiatry, The University of Iowa, Iowa City, IA, United States
| | - Joel C Geerling
- Geerling Laboratory, Department of Neurology, Iowa Neuroscience Institute, The University of Iowa, Iowa City, IA, United States
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16
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Kaminski J, Bowren M, Manzel K, Tranel D. Neural correlates of recognition and naming of famous persons and landmarks: A special role for the left anterior temporal lobe. HANDBOOK OF CLINICAL NEUROLOGY 2022; 187:303-317. [PMID: 35964980 DOI: 10.1016/b978-0-12-823493-8.00023-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The anterior temporal lobes (ATLs) have been shown to be crucial for recognition and naming of unique entities such as persons and places. In this chapter, we review previous research that identified the neural underpinnings of these processes, and discuss the convergence zone theory of conceptual knowledge and proper name retrieval. Lesion-deficit and neuroimaging studies have found that the temporal poles are essential for recognition and naming of unique persons and places. Research has shown laterality, in that the right anterior temporal pole is specialized for recognition and the left for naming. Here, we analyzed recognition and naming of persons and landmarks in a large neurologic sample (N=244) using the Iowa Famous Faces and Famous Landmarks tests. For both categories, education had a significant effect on recognition and naming performances, but age and gender did not. Lesion-symptom maps revealed lower naming scores for both Faces and Landmarks associated with lesions to the anterior and mesial left temporal lobe. Lower recognition scores were also linked to left temporal lobe damage, possibly due to the method we used for measuring recognition (verbally based). Overall, the results demonstrate the importance of the temporal lobes for recognition and naming of unique persons and places.
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Affiliation(s)
- Jamie Kaminski
- Division of Neuropsychology and Cognitive Neuroscience, Departments of Neurology and Psychological and Brain Sciences, University of Iowa, Iowa City, IA, United States
| | - Mark Bowren
- Division of Neuropsychology and Cognitive Neuroscience, Departments of Neurology and Psychological and Brain Sciences, University of Iowa, Iowa City, IA, United States
| | - Kenneth Manzel
- Division of Neuropsychology and Cognitive Neuroscience, Departments of Neurology and Psychological and Brain Sciences, University of Iowa, Iowa City, IA, United States
| | - Daniel Tranel
- Division of Neuropsychology and Cognitive Neuroscience, Departments of Neurology and Psychological and Brain Sciences, University of Iowa, Iowa City, IA, United States.
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17
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Enciso-Olivera CO, Ordóñez-Rubiano EG, Casanova-Libreros R, Rivera D, Zarate-Ardila CJ, Rudas J, Pulido C, Gómez F, Martínez D, Guerrero N, Hurtado MA, Aguilera-Bustos N, Hernández-Torres CP, Hernandez J, Marín-Muñoz JH. Structural and functional connectivity of the ascending arousal network for prediction of outcome in patients with acute disorders of consciousness. Sci Rep 2021; 11:22952. [PMID: 34824383 PMCID: PMC8617304 DOI: 10.1038/s41598-021-98506-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/20/2021] [Indexed: 11/24/2022] Open
Abstract
To determine the role of early acquisition of blood oxygen level-dependent (BOLD) signals and diffusion tensor imaging (DTI) for analysis of the connectivity of the ascending arousal network (AAN) in predicting neurological outcomes after acute traumatic brain injury (TBI), cardiopulmonary arrest (CPA), or stroke. A prospective analysis of 50 comatose patients was performed during their ICU stay. Image processing was conducted to assess structural and functional connectivity of the AAN. Outcomes were evaluated after 3 and 6 months. Nineteen patients (38%) had stroke, 18 (36%) CPA, and 13 (26%) TBI. Twenty-three patients were comatose (44%), 11 were in a minimally conscious state (20%), and 16 had unresponsive wakefulness syndrome (32%). Univariate analysis demonstrated that measurements of diffusivity, functional connectivity, and numbers of fibers in the gray matter, white matter, whole brain, midbrain reticular formation, and pontis oralis nucleus may serve as predictive biomarkers of outcome depending on the diagnosis. Multivariate analysis demonstrated a correlation of the predicted value and the real outcome for each separate diagnosis and for all the etiologies together. Findings suggest that the above imaging biomarkers may have a predictive role for the outcome of comatose patients after acute TBI, CPA, or stroke.
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Affiliation(s)
- Cesar O Enciso-Olivera
- Department of Critical Care and Intensive Care Unit, Fundación Universitaria de Ciencias de La Salud (FUCS), Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Edgar G Ordóñez-Rubiano
- Department of Neurological Surgery, Fundación Universitaria de Ciencias de La Salud (FUCS), Hospital de San José, Bogotá, Colombia
| | - Rosángela Casanova-Libreros
- Division of Clinical Research, Fundación Universitaria de Ciencias de La Salud (FUCS), Hospital de San José, Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Diana Rivera
- Division of Clinical Research, Fundación Universitaria de Ciencias de La Salud (FUCS), Hospital de San José, Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Carol J Zarate-Ardila
- Division of Clinical Research, Fundación Universitaria de Ciencias de La Salud (FUCS), Hospital de San José, Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Jorge Rudas
- Department of Biotechnology, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Cristian Pulido
- Department of Mathematics, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Francisco Gómez
- Department of Computer Science, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Darwin Martínez
- Department of Computer Science, Universidad Central, Bogotá, Colombia
| | - Natalia Guerrero
- Department of Radiology, Fundación Universitaria de Ciencias de La Salud (FUCS), Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Mayra A Hurtado
- Department of Critical Care and Intensive Care Unit, Fundación Universitaria de Ciencias de La Salud (FUCS), Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Natalia Aguilera-Bustos
- Division of Clinical Research, Fundación Universitaria de Ciencias de La Salud (FUCS), Hospital de San José, Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Clara P Hernández-Torres
- Department of Psychology, Fundación Universitaria de Ciencias de La Salud (FUCS), Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - José Hernandez
- Department of Neurology, Fundación Universitaria de Ciencias de La Salud (FUCS), Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Jorge H Marín-Muñoz
- Department of Radiology, Fundación Universitaria de Ciencias de La Salud (FUCS), Hospital Infantil Universitario de San José, Bogotá, Colombia. .,Innovation and Research Division, Imaging Experts and Healthcare Services (ImexHS), Street 92 # 11-51, Of 202, Bogotá, Colombia.
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18
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Electrocorticography reveals thalamic control of cortical dynamics following traumatic brain injury. Commun Biol 2021; 4:1210. [PMID: 34675341 PMCID: PMC8531397 DOI: 10.1038/s42003-021-02738-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 09/15/2021] [Indexed: 12/26/2022] Open
Abstract
The return of consciousness after traumatic brain injury (TBI) is associated with restoring complex cortical dynamics; however, it is unclear what interactions govern these complex dynamics. Here, we set out to uncover the mechanism underlying the return of consciousness by measuring local field potentials (LFP) using invasive electrophysiological recordings in patients recovering from TBI. We found that injury to the thalamus, and its efferent projections, on MRI were associated with repetitive and low complexity LFP signals from a highly structured phase space, resembling a low-dimensional ring attractor. But why do thalamic injuries in TBI patients result in a cortical attractor? We built a simplified thalamocortical model, which connotes that thalamic input facilitates the formation of cortical ensembles required for the return of cognitive function and the content of consciousness. These observations collectively support the view that thalamic input to the cortex enables rich cortical dynamics associated with consciousness.
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19
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Huang Z, Tarnal V, Vlisides PE, Janke EL, McKinney AM, Picton P, Mashour GA, Hudetz AG. Asymmetric neural dynamics characterize loss and recovery of consciousness. Neuroimage 2021; 236:118042. [PMID: 33848623 PMCID: PMC8310457 DOI: 10.1016/j.neuroimage.2021.118042] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/01/2021] [Accepted: 04/04/2021] [Indexed: 02/07/2023] Open
Abstract
Anesthetics are known to disrupt neural interactions in cortical and subcortical brain circuits. While the effect of anesthetic drugs on consciousness is reversible, the neural mechanism mediating induction and recovery may be different. Insight into these distinct mechanisms can be gained from a systematic comparison of neural dynamics during slow induction of and emergence from anesthesia. To this end, we used functional magnetic resonance imaging (fMRI) data obtained in healthy volunteers before, during, and after the administration of propofol at incrementally adjusted target concentrations. We analyzed functional connectivity of corticocortical and subcorticocortical networks and the temporal autocorrelation of fMRI signal as an index of neural processing timescales. We found that en route to unconsciousness, temporal autocorrelation across the entire brain gradually increased, whereas functional connectivity gradually decreased. In contrast, regaining consciousness was associated with an abrupt restoration of cortical but not subcortical temporal autocorrelation and an abrupt boost of subcorticocortical functional connectivity. Pharmacokinetic effects could not account for the difference in neural dynamics between induction and emergence. We conclude that the induction and recovery phases of anesthesia follow asymmetric neural dynamics. A rapid increase in the speed of cortical neural processing and subcorticocortical neural interactions may be a mechanism that reboots consciousness.
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Affiliation(s)
- Zirui Huang
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI 48109, USA; Center for Consciousness Science, University of Michigan Medical School, Ann Arbor, MI 48109, USA.
| | - Vijay Tarnal
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI 48109, USA; Center for Consciousness Science, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Phillip E Vlisides
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI 48109, USA; Center for Consciousness Science, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Ellen L Janke
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI 48109, USA; Center for Consciousness Science, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Amy M McKinney
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Paul Picton
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - George A Mashour
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI 48109, USA; Center for Consciousness Science, University of Michigan Medical School, Ann Arbor, MI 48109, USA; Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI 48109, USA
| | - Anthony G Hudetz
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI 48109, USA; Center for Consciousness Science, University of Michigan Medical School, Ann Arbor, MI 48109, USA; Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI 48109, USA.
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20
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Huels ER, Groenhout T, Fields CW, Liu T, Mashour GA, Pal D. Inactivation of Prefrontal Cortex Delays Emergence From Sevoflurane Anesthesia. Front Syst Neurosci 2021; 15:690717. [PMID: 34305541 PMCID: PMC8299111 DOI: 10.3389/fnsys.2021.690717] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 06/10/2021] [Indexed: 01/21/2023] Open
Abstract
Studies aimed at investigating brain regions involved in arousal state control have been traditionally limited to subcortical structures. In the current study, we tested the hypothesis that inactivation of prefrontal cortex, but not two subregions within parietal cortex—somatosensory barrel field and medial/lateral parietal association cortex—would suppress arousal, as measured by an increase in anesthetic sensitivity. Male and female Sprague Dawley rats were surgically prepared for recording electroencephalogram and bilateral infusion into prefrontal cortex (N = 13), somatosensory barrel field (N = 10), or medial/lateral parietal association cortex (N = 9). After at least 10 days of post-surgical recovery, 156 μM tetrodotoxin or saline was microinjected into one of the cortical sites. Ninety minutes after injection, rats were anesthetized with 2.5% sevoflurane and the time to loss of righting reflex, a surrogate for loss of consciousness, was measured. Sevoflurane was stopped after 45 min and the time to return of righting reflex, a surrogate for return of consciousness, was measured. Tetrodotoxin-mediated inactivation of all three cortical sites decreased (p < 0.05) the time to loss of righting reflex. By contrast, only inactivation of prefrontal cortex, but not somatosensory barrel field or medial/lateral parietal association cortex, increased (p < 0.001) the time to return of righting reflex. Burst suppression ratio was not altered following inactivation of any of the cortical sites, suggesting that there was no global effect due to pharmacologic lesion. These findings demonstrate that prefrontal cortex plays a causal role in emergence from anesthesia and behavioral arousal.
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Affiliation(s)
- Emma R Huels
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States.,Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, United States.,Center for Consciousness Science, University of Michigan, Ann Arbor, MI, United States
| | - Trent Groenhout
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Christopher W Fields
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Tiecheng Liu
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - George A Mashour
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States.,Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, United States.,Center for Consciousness Science, University of Michigan, Ann Arbor, MI, United States
| | - Dinesh Pal
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States.,Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, United States.,Center for Consciousness Science, University of Michigan, Ann Arbor, MI, United States
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21
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Abstract
PURPOSE OF REVIEW In the study of brain-injured patients with disorders of consciousness (DoC), structural and functional MRI seek to provide insights into the neural correlates of consciousness, identify neurophysiologic signatures of covert consciousness, and identify biomarkers for recovery of consciousness. RECENT FINDINGS Cortical volume, white matter volume and integrity, and structural connectivity across many grey and white matter regions have been shown to vary with level of awareness in brain-injured patients. Resting-state functional connectivity (rs-FC) within and between canonical cortical networks also correlates with DoC patients' level of awareness. Stimulus-based and motor-imagery fMRI paradigms have identified some behaviorally unresponsive DoC patients with cortical processing and activation patterns that mirror healthy controls. Emerging techniques like dynamic rs-FC have begun to identify temporal trends in brain-wide connectivity that may represent novel neural correlates of consciousness. SUMMARY Structural and functional MRI will continue to advance our understanding of brain regions supporting human consciousness. Measures of regional and global white matter integrity and rs-FC in particular networks have shown significant improvement over clinical features in identifying acute and chronic DoC patients likely to recover awareness. As they are refined, functional MRI paradigms may additionally provide opportunities for interacting with behaviorally unresponsive patients.
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22
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Gottlieb E, Egorova N, Khlif MS, Khan W, Werden E, Pase MP, Howard M, Brodtmann A. Regional neurodegeneration correlates with sleep-wake dysfunction after stroke. Sleep 2021; 43:5813630. [PMID: 32249910 DOI: 10.1093/sleep/zsaa054] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 03/19/2020] [Indexed: 12/13/2022] Open
Abstract
Sleep-wake disruption is a key modifiable risk factor and sequela of stroke. The pathogenesis of poststroke sleep dysfunction is unclear. It is not known whether poststroke sleep pathology is due to focal infarction to sleep-wake hubs or to accelerated poststroke neurodegeneration in subcortical structures after stroke. We characterize the first prospective poststroke regional brain volumetric and whole-brain, fiber-specific, white matter markers of objectively measured sleep-wake dysfunction. We hypothesized that excessively long sleep (>8 h) duration and poor sleep efficiency (<80%) measured using the SenseWear Armband 3-months poststroke (n = 112) would be associated with reduced regional brain volumes of a priori-selected sleep-wake regions of interest when compared to healthy controls with optimal sleep characteristics (n = 35). We utilized a novel technique known as a whole-brain fixel-based analysis to investigate the fiber-specific white matter differences in participants with long sleep duration. Stroke participants with long sleep (n = 24) duration exhibited reduced regional volumes of the ipsilesional thalamus and contralesional amygdala when compared with controls. Poor sleep efficiency after stroke (n = 29) was associated with reduced ipsilesional thalamus, contralesional hippocampus, and contralesional amygdala volumes. Whole-brain fixel-based analyses revealed widespread macrostructural degeneration to the corticopontocerebellar tract in stroke participants with long sleep duration, with fiber reductions of up to 40%. Neurodegeneration to subcortical structures, which appear to be vulnerable to accelerated brain volume loss after stroke, may drive sleep-wake deficiencies poststroke, independent of lesion characteristics and confounding comorbidities. We discuss these findings in the context of the clinicopathological implications of sleep-related neurodegeneration and attempt to corroborate previous mechanistic-neuroanatomical findings.
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Affiliation(s)
- Elie Gottlieb
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Natalia Egorova
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Mohamed S Khlif
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Wasim Khan
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,Department of Neuroimaging, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College, London, UK
| | - Emilio Werden
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Matthew P Pase
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia.,Harvard T.H. Chan School of Public Health, Harvard University, MA
| | - Mark Howard
- University of Melbourne, Melbourne, Victoria, Australia.,Austin Health, Heidelberg, Victoria, Australia.,Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Amy Brodtmann
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
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23
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Mulkey M, Everhart DE, Gencarelli A, Sorrell A, Kim S. A Review of Neuronal Pathways Associated With Consciousness. J Neurosci Nurs 2021; 53:39-43. [PMID: 33252410 PMCID: PMC8127025 DOI: 10.1097/jnn.0000000000000559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT INTRODUCTION: Accurate communication of information regarding fluctuations in level of consciousness is critical. It is, important for nurses to understand terms related to consciousness to appropriately assess and implement plans of care. CONTENT: Although the neurobiology of consciousness is complex and multifaceted, consciousness can be conceptualized as having 2 distinct but interrelated dimensions: arousal and awareness. The different levels of consciousness are thought to fall on a continuum ranging from being fully awake to coma. CONCLUSION: This article focuses on the terms of consciousness, awareness, and arousal along with nursing implications where appropriate.
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Multivariate Lesion-Behavior Mapping of General Cognitive Ability and Its Psychometric Constituents. J Neurosci 2020; 40:8924-8937. [PMID: 33046547 DOI: 10.1523/jneurosci.1415-20.2020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/15/2020] [Accepted: 10/01/2020] [Indexed: 01/09/2023] Open
Abstract
General cognitive ability, or general intelligence (g), is central to cognitive science, yet the processes that constitute it remain unknown, in good part because most prior work has relied on correlational methods. Large-scale behavioral and neuroanatomical data from neurologic patients with focal brain lesions can be leveraged to advance our understanding of the key mechanisms of g, as this approach allows inference on the independence of cognitive processes along with elucidation of their respective neuroanatomical substrates. We analyzed behavioral and neuroanatomical data from 402 humans (212 males; 190 females) with chronic, focal brain lesions. Structural equation models (SEMs) demonstrated a psychometric isomorphism between g and working memory in our sample (which we refer to as g/Gwm), but not between g and other cognitive abilities. Multivariate lesion-behavior mapping analyses indicated that g and working memory localize most critically to a site of converging white matter tracts deep to the left temporo-parietal junction. Tractography analyses demonstrated that the regions in the lesion-behavior map of g/Gwm were primarily associated with the arcuate fasciculus. The anatomic findings were validated in an independent cohort of acute stroke patients (n = 101) using model-based predictions of cognitive deficits generated from the Iowa cohort lesion-behavior maps. The neuroanatomical localization of g/Gwm provided the strongest prediction of observed g in the new cohort (r = 0.42, p < 0.001), supporting the anatomic specificity of our findings. These results provide converging behavioral and anatomic evidence that working memory is a key mechanism contributing to domain-general cognition.SIGNIFICANCE STATEMENT General cognitive ability (g) is thought to play an important role in individual differences in adaptive behavior, yet its core processes remain unknown, in large part because of difficulties in making causal inferences from correlated data. Using data from patients with focal brain damage, we demonstrate that there is a strong psychometric correspondence between g and working memory - the ability to maintain and control mental information, and that the critical neuroanatomical substrates of g and working memory include the arcuate fasciculus. This work provides converging behavioral and neuroanatomical evidence that working memory is a key mechanism contributing to domain-general cognition.
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Huang D, Grady FS, Peltekian L, Geerling JC. Efferent projections of Vglut2, Foxp2, and Pdyn parabrachial neurons in mice. J Comp Neurol 2020; 529:657-693. [PMID: 32621762 DOI: 10.1002/cne.24975] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 12/16/2022]
Abstract
The parabrachial nucleus (PB) is a complex structure located at the junction of the midbrain and hindbrain. Its neurons have diverse genetic profiles and influence a variety of homeostatic functions. While its cytoarchitecture and overall efferent projections are known, we lack comprehensive information on the projection patterns of specific neuronal subtypes in the PB. In this study, we compared the projection patterns of glutamatergic neurons here with a subpopulation expressing the transcription factor Foxp2 and a further subpopulation expressing the neuropeptide Pdyn. To do this, we injected an AAV into the PB region to deliver a Cre-dependent anterograde tracer (synaptophysin-mCherry) in three different strains of Cre-driver mice. We then analyzed 147 neuroanatomical regions for labeled boutons in every brain (n = 11). Overall, glutamatergic neurons in the PB region project to a wide variety of sites in the cerebral cortex, basal forebrain, bed nucleus of the stria terminalis, amygdala, diencephalon, and brainstem. Foxp2 and Pdyn subpopulations project heavily to the hypothalamus, but not to the cortex, basal forebrain, or amygdala. Among the few differences between Foxp2 and Pdyn cases was a notable lack of Pdyn projections to the ventromedial hypothalamic nucleus. Our results indicate that genetic identity determines connectivity (and therefore, function), providing a framework for mapping all PB output projections based on the genetic identity of its neurons. Using genetic markers to systematically classify PB neurons and their efferent projections will enhance the translation of research findings from experimental animals to humans.
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Affiliation(s)
- Dake Huang
- Department of Neurology, University of Iowa, Iowa City, Iowa, USA
| | - Fillan S Grady
- Department of Neurology, University of Iowa, Iowa City, Iowa, USA
| | - Lila Peltekian
- Department of Neurology, University of Iowa, Iowa City, Iowa, USA
| | - Joel C Geerling
- Department of Neurology, University of Iowa, Iowa City, Iowa, USA
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26
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Snider SB, Hsu J, Darby RR, Cooke D, Fischer D, Cohen AL, Grafman JH, Fox MD. Cortical lesions causing loss of consciousness are anticorrelated with the dorsal brainstem. Hum Brain Mapp 2020. [DOI: 10.1002/hbm.24892#.xho8mgjbvfa.twitter] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Samuel B. Snider
- Departments of Neurology, Massachusetts General Hospital and Brigham and Women's HospitalHarvard Medical School Boston Massachusetts
| | - Joey Hsu
- Berenson‐Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of NeurologyBeth Israel Deaconess Medical Center Boston Massachusetts
| | - R. Ryan Darby
- Department of NeurologyVanderbilt University Medical Center Nashville Tennessee
| | - Danielle Cooke
- Berenson‐Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of NeurologyBeth Israel Deaconess Medical Center Boston Massachusetts
| | - David Fischer
- Departments of Neurology, Massachusetts General Hospital and Brigham and Women's HospitalHarvard Medical School Boston Massachusetts
| | - Alexander L. Cohen
- Berenson‐Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of NeurologyBeth Israel Deaconess Medical Center Boston Massachusetts
- Department of NeurologyBoston Children's Hospital, Harvard Medical School Boston Massachusetts
| | - Jordan H. Grafman
- Rehabilitation Institute of Chicago Chicago Illinois
- Department of Physical Medicine and Rehabilitation, Neurology, Cognitive Neurology and Alzheimer's Center, Department of Psychiatry, Feinberg School of Medicine and Department of Psychology, Weinberg College of Arts and SciencesNorthwestern University Chicago Illinois
| | - Michael D. Fox
- Berenson‐Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of NeurologyBeth Israel Deaconess Medical Center Boston Massachusetts
- Department of Neurology, Massachusetts General HospitalHarvard Medical School Boston Massachusetts
- Athinoula A. Martinos Center for Biomedical Imaging Charlestown Massachusetts
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27
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Snider SB, Hsu J, Darby RR, Cooke D, Fischer D, Cohen AL, Grafman JH, Fox MD. Cortical lesions causing loss of consciousness are anticorrelated with the dorsal brainstem. Hum Brain Mapp 2020; 41:1520-1531. [PMID: 31904898 PMCID: PMC7268053 DOI: 10.1002/hbm.24892] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/11/2019] [Accepted: 11/27/2019] [Indexed: 01/01/2023] Open
Abstract
Brain lesions can provide unique insight into the neuroanatomical substrate of human consciousness. For example, brainstem lesions causing coma map to a specific region of the tegmentum. Whether specific lesion locations outside the brainstem are associated with loss of consciousness (LOC) remains unclear. Here, we investigate the topography of cortical lesions causing prolonged LOC (N = 16), transient LOC (N = 91), or no LOC (N = 64). Using standard voxel lesion symptom mapping, no focus of brain damage was associated with LOC. Next, we computed the network of brain regions functionally connected to each lesion location using a large normative connectome dataset (N = 1,000). This technique, termed lesion network mapping, can test whether lesions causing LOC map to a connected brain circuit rather than one brain region. Connectivity between cortical lesion locations and an a priori coma-specific region of brainstem tegmentum was an independent predictor of LOC (B = 1.2, p = .004). Connectivity to the dorsal brainstem was the only predictor of LOC in a whole-brain voxel-wise analysis. This relationship was driven by anticorrelation (negative correlation) between lesion locations and the dorsal brainstem. The map of regions anticorrelated to the dorsal brainstem thus defines a distributed brain circuit that, when damaged, is most likely to cause LOC. This circuit showed a slight posterior predominance and had peaks in the bilateral claustrum. Our results suggest that cortical lesions causing LOC map to a connected brain circuit, linking cortical lesions that disrupt consciousness to brainstem sites that maintain arousal.
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Affiliation(s)
- Samuel B Snider
- Departments of Neurology, Massachusetts General Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joey Hsu
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - R Ryan Darby
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Danielle Cooke
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - David Fischer
- Departments of Neurology, Massachusetts General Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexander L Cohen
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jordan H Grafman
- Rehabilitation Institute of Chicago, Chicago, Illinois.,Department of Physical Medicine and Rehabilitation, Neurology, Cognitive Neurology and Alzheimer's Center, Department of Psychiatry, Feinberg School of Medicine and Department of Psychology, Weinberg College of Arts and Sciences, Northwestern University, Chicago, Illinois
| | - Michael D Fox
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts
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28
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Schiff ND. Resolving the role of the paramedian thalamus in forebrain arousal mechanisms. Ann Neurol 2019; 84:812-813. [PMID: 30421449 DOI: 10.1002/ana.25378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/01/2018] [Accepted: 11/04/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Nicholas D Schiff
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY
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29
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Gao S, Proekt A, Renier N, Calderon DP, Pfaff DW. Activating an anterior nucleus gigantocellularis subpopulation triggers emergence from pharmacologically-induced coma in rodents. Nat Commun 2019; 10:2897. [PMID: 31263107 PMCID: PMC6603023 DOI: 10.1038/s41467-019-10797-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 06/01/2019] [Indexed: 02/08/2023] Open
Abstract
Multiple areas within the reticular activating system (RAS) can hasten awakening from sleep or light planes of anesthesia. However, stimulation in individual sites has shown limited recovery from deep global suppression of brain activity, such as coma. Here we identify a subset of RAS neurons within the anterior portion of nucleus gigantocellularis (aNGC) capable of producing a high degree of awakening represented by a broad high frequency cortical reactivation associated with organized movements and behavioral reactivity to the environment from two different models of deep pharmacologically-induced coma (PIC): isoflurane (1.25%-1.5%) and induced hypoglycemic coma. Activating aNGC neurons triggered awakening by recruiting cholinergic, noradrenergic, and glutamatergic arousal pathways. In summary, we identify an evolutionarily conserved population of RAS neurons, which broadly restore cerebral cortical activation and motor behavior in rodents through the coordinated activation of multiple arousal-promoting circuits.
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Affiliation(s)
- S Gao
- Department of Anesthesiology, Weill Cornell Medical College, New York, NY, 10065, USA
| | - A Proekt
- Department of Anesthesiology, Weill Cornell Medical College, New York, NY, 10065, USA
- Laboratory of Neurobiology and Behavior, the Rockefeller University, New York, NY, 10065, USA
| | - N Renier
- ICM, Brain and Spine Institute, Hopital de la Pitie-Salpetriere, Sorbonne Universite, Inserm, CNRS, Paris, 75013, France
| | - D P Calderon
- Department of Anesthesiology, Weill Cornell Medical College, New York, NY, 10065, USA.
- Laboratory of Neurobiology and Behavior, the Rockefeller University, New York, NY, 10065, USA.
| | - D W Pfaff
- Laboratory of Neurobiology and Behavior, the Rockefeller University, New York, NY, 10065, USA
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30
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Guaraldi P, Calandra‐Buonaura G, Provini F, Cortelli P. Role of Thalamus in Sleep–Wake Cycle Regulation. Ann Neurol 2019; 85:611. [DOI: 10.1002/ana.25449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/12/2019] [Indexed: 11/11/2022]
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31
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Deep structural brain lesions associated with consciousness impairment early after hemorrhagic stroke. Sci Rep 2019; 9:4174. [PMID: 30862910 PMCID: PMC6414498 DOI: 10.1038/s41598-019-41042-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 02/26/2019] [Indexed: 12/15/2022] Open
Abstract
The purpose of this study was to determine the significance of deep structural lesions for impairment of consciousness following hemorrhagic stroke and recovery at ICU discharge. Our study focused on deep lesions that previously were implicated in studies of disorders of consciousness. We analyzed MRI measures obtained within the first week of the bleed and command following throughout the ICU stay. A machine learning approach was applied to identify MRI findings that best predicted the level consciousness. From 158 intracerebral hemorrhage patients that underwent MRI, one third was unconscious at the time of MRI and half of these patients recovered consciousness by ICU discharge. Deep structural lesions predicted both, impairment and recovery of consciousness, together with established measures of mass effect. Lesions in the midbrain peduncle and pontine tegmentum alongside the caudate nucleus were implicated as critical structures. Unconscious patients predicted to recover consciousness by ICU discharge had better long-term functional outcomes than those predicted to remain unconscious.
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