Persistent states of reduced consciousness such as the vegetative and the minimally consciousness state (MCS) may be the result of severe traumatic brain injury (TBI). In these conditions, the level of consciousness is challenging to diagnose correctly, and diagnostic error rates are high [1]. Recently, there has been major progress in the study of disorders of consciousness [2–4], and today there exist valid functional magnetic resonance imaging (fMRI) protocols to probe for willful cognitive processing [5]. These protocols are based on verbal instructions to imagine a motor task and a spatial navigation task that activate the supplementary motor area (SMA) and the parahippocampal gyrus (PG), respectively [5]. If a patient displays bloodoxygenation-level-dependent (BOLD) responses similar to the activation seen in healthy controls, it can be assumed that conscious cognitive processing is present. Conversely, negative neurophysiological findings are not evidence for lack of consciousness, because false-negative results are common even in healthy controls [3]. Here we describe the case of a 20-year-old woman who sustained TBI after a traffic accident. At arrival at the hospital, her Glasgow Coma Scale score was 3. Computed tomography (CT) revealed diffuse edema and intracranial hematoma over the left hemisphere that was immediately evacuated. Twelve months post ictus, she was not able to produce verbal or motor responses and was diagnosed to be in MCS. During this time, she had been repeatedly tested with the Coma Recovery Scale–Revised (CRS-R) [6]; minimum score was 5 (2 months post ictus) and maximum 11 at the time of scanning, mainly based on visual functioning. Furthermore, it was occasionally observed that she showed facial emotional responses, and that she produced laughter-like sounds when hearing jokes. Therefore, we measured the patient’s brain responses for receptive language processing and voluntary mental activity using fMRI. Receptive language processing was assessed by a passive-listening task [7]. Two imagery tasks were verbally presented in the scanner: to imagine walking through her home, and to imagine playing tennis, with similar fMRI parameters as in Owen and colleges [3]. Eight healthy females (age 20–22 years) were tested on the same tasks and served as controls. The fMRI examination revealed that she displayed cortical responses similar to the control group on the language task and on the tennis task, but she did not display similar activation as healthy controls in the PG during the navigation task (Fig. 1). The latter might be due to lesions in her PG (confirmed by structural MRI), an area that is important for spatial imagery processing [8]. The similarity in the activation between the patient and the controls indicates that the patient cooperated with the instructions during the scan. This suggests that she P. M. Aslaksen and T. R. Vangberg contributed equally to this work.