Abstract
Differences in the functional integrity of the brain from acute severe brain injury to subsequent recovery of consciousness have not been well documented. Functional magnetic resonance imaging (fMRI) may elucidate this issue as it allows for the objective measurement of brain function both at rest and in response to stimuli. Here, we report the cortical function of a patient with a severe traumatic brain injury (TBI) in a critically ill state and at subsequent functional recovery 9-months post injury. A series of fMRI paradigms were employed to assess sound and speech perception, command following, and resting state connectivity. The patient retained sound perception and speech perception acutely, as indexed by his fMRI responses. Command following was absent acutely, but was present at recovery. Increases in functional connectivity across multiple resting state networks were observed at recovery. We demonstrate the clinical utility of fMRI in assessing cortical function in a patient with severe TBI. We suggest that hallmarks of the recovery of consciousness are associated with neural activity to higher-order cognitive tasks and increased resting state connectivity.
Highlights
Assessing cortical activity in critically ill brain injured patients following severe traumatic brain injury (TBI) is a complex clinical undertaking [1]
Our results suggest that functional reorganization occurs during emergence from coma and that this reorganization allows for higher-order cognitive processing to occur, as seen in the positive command following result
We described a patient who sustained a severe TBI resulting in coma
Summary
Assessing cortical activity in critically ill brain injured patients following severe traumatic brain injury (TBI) is a complex clinical undertaking [1]. Bedside behavioural examinations are used to evaluate the functional integrity of the brain and by extension, the level of consciousness a patient retains in a critical care environment [2,3]. A clear understanding of a patient’s cortical function in the intensive care unit is imperative as it informs critical decisions regarding the continuation of care or the withdrawal of life-sustaining therapy [6]. For these reasons, there is a pressing need for objective and reliable measures of cortical activity in critically-ill patients who have sustained a severe brain injury.
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