Fischer DB, Boes AD, Demertzi A, Evrard HC, Laureys S, Edlow
BL, Liu H, Saper CB, Pascual-Leone A, Fox MD, Geerling JC. A human brain
network derived from coma-causing brainstem lesions. Neurology. 2016 Dec
6;87(23):2427-2434. PubMed PMID: 27815400.
Abstract
OBJECTIVE:
To characterize a brainstem location specific to
coma-causing lesions, and its functional connectivity network.
METHODS:
We compared 12 coma-causing brainstem lesions to 24 control
brainstem lesions using voxel-based lesion-symptom mapping in a case-control
design to identify a site significantly associated with coma. We next used
resting-state functional connectivity from a healthy cohort to identify a
network of regions functionally connected to this brainstem site. We further
investigated the cortical regions of this network by comparing their spatial
topography to that of known networks and by evaluating their functional
connectivity in patients with disorders of consciousness.
RESULTS:
A small region in the rostral dorsolateral pontine tegmentum
was significantly associated with coma-causing lesions. In healthy adults, this
brainstem site was functionally connected to the ventral anterior insula (AI)
and pregenual anterior cingulate cortex (pACC). These cortical areas aligned
poorly with previously defined resting-state networks, better matching the
distribution of von Economo neurons. Finally, connectivity between the AI and
pACC was disrupted in patients with disorders of consciousness, and to a
greater degree than other brain networks.
CONCLUSIONS:
Injury to a small region in the pontine tegmentum is
significantly associated with coma. This brainstem site is functionally
connected to 2 cortical regions, the AI and pACC, which become disconnected in
disorders of consciousness. This network of brain regions may have a role in
the maintenance of human consciousness.
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