Functional Neuroimaging Applications for Assessment and Rehabilitation Planning in Patients With Disorders of Consciousness

The vegetative state as a “disconnection syndrome.” Characteristic of the vegetative state is the metabolic impairment in a wide frontoparietal cortical network encompassing medial and lateral prefrontal and parietal multimodal associative areas. This might be due to either direct cortical damage or to cortico-cortical or cortico-thalamo-cortical disconnections (schematized by blue arrows; the square represents nonspecific thalamic nuclei). Adapted from Laureys et al.

Brain regions, shown in red, that activated during (A) visual, (B) auditory, and (C) noxious stimulation in patients in the vegetative state.

BOLD signal increases during the forward (yellow) and backward (blue) conditions, and with the forward and backward conditions superimposed (red) in (A) patient 1, (B) patient 2, and (C) and healthy volunteers. Arrows indicate active language network foci in the 2 minimally conscious state patients. Adapted with permission from Schiff et al.⁴⁹

Viewing pictures: Patient 3. BOLD signal increases observed in a minimally conscious-state patient during passive viewing of the (A) faces, (B) hands, and (C) landscapes. Images on the black background were analyzed with Statistical Parametric Mapping. Images on the grid background were identified by a multistage statistical analysis that compared average signals acquired during baseline and stimulation epochs. Circles indicate areas of activation common to both analyses. Abbreviations: L, left; R, right.