Abstract
Differential diagnosis of unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS) is one of the most challenging problems for specialists who deal with chronic disorders of consciousness (DOC). The aim of the current study was to develop a conventional MRI-based scale and to evaluate its role in distinguishing chronic disorders of consciousness (Disorders of Consciousness MRI-based Distinguishing Scale, DOC-MRIDS). Data were acquired from 30 patients with clinically diagnosed chronic disorders of consciousness. All patients underwent conventional MRI using a Siemens Verio 3.0 T scanner, which included T2 and T1 sequences for patient assessment. Diffuse cortical atrophy, ventricular enlargement, sulcal widening, leukoaraiosis, brainstem and/or thalamus degeneration, corpus callosum degeneration, and corpus callosum lesions were assessed according to DOC-MRIDS criteria, with a total score calculation. The ROC-analysis showed that a reasonable threshold DOC-MRIDS total score was 5.5, that is, patients with DOC-MRIDS total score of 6 and above were classified as UWS and 5 and below as MCS, with sensitivity of 82.4% and specificity of 92.3%. The novel structural MRI-based scale for the assessment of typical brain lesions in patients with chronic DOC is relatively easy to apply, and provides good specificity and sensitivity values for discrimination between UWS and MCS.
Highlights
In clinical practice, the term “consciousness” has two dimensions: wakefulness and awareness [1,2].Lack of awareness in patients who have regained arousal after coma is usually the result of extensive damage of several awareness-related structures [3]
Differential diagnosis of unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS) is one of the most challenging problems for specialists who deal with chronic disorders of consciousness
The aim of the current study was to develop a conventional MRI-based scale that included the most common and clinically important structural damage found in patients with DOC, and to evaluate its role in distinguishing between the types of chronic disorders of consciousness (Disorders of Consciousness MRI-based Distinguishing Scale, DOC-MRIDS)
Summary
Lack of awareness in patients who have regained arousal after coma is usually the result of extensive damage of several awareness-related structures [3]. As these patients maintain complete or partial preservation of hypothalamic and brainstem autonomic function (e.g., and circulation and spontaneous breathing, such condition, that is, chronic disorders of consciousness (DOC) may remain stable for a prolonged period [4]. According to the Multi-Society Task Force definition, unresponsive wakefulness syndrome is a clinical condition of complete unawareness of the self and the environment, with preserved sleep-wake cycles and hypothalamic and brainstem autonomic functions [7]. Minimally conscious state patients are able to demonstrate minimal but definite and reproducible behavioural evidence of self or environmental awareness [6]
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