Advances in neuroimaging techniques hold significant promise for improving understanding of disorders of consciousness arising from severe brain injuries. We review neuroimaging studies of the vegetative state (VS) and minimally conscious state (MCS), and findings in an unusual case of late emergence from MCS. Multimodal neuroimaging studies using positron emission tomography techniques, functional magnetic resonance imaging, and quantitative electroencephalography and magnetoencephalography quantify variations of residual cerebral activity across these patient populations. The results suggest models to distinguish the pathophysiologic basis of VS and MCS. Less clear are potential brain mechanisms underlying late recovery of communication in rare MCS patients. Diffusion tensor magnetic resonance imaging studies and recent experimental findings suggest that structural remodeling of the brain following severe injury may play a role in late functional recoveries. More generally, relatively long time courses of recovery following severe brain injury emphasize the need to develop markers for identifying patients who may harbor potential for further meaningful recovery. Introduction of neuroimaging into the clinical evaluation process will require developing frameworks for longitudinal assessments of cerebral function. Although limited in number, available studies already provide important insights into underlying brain mechanisms that may help guide development of such assessment strategies.
Department of Neurology and Neuroscience, Weill Medical College of Cornell University, New York.
Corresponding author: Nicholas D. Schiff, MD, Department of Neurology and Neuroscience, Weill Medical College of Cornell University, 1300 York Ave, Room F610, New York, NY 10021 (e-mail: firstname.lastname@example.org).
This article was initially presented at the plenary session of the “2nd Federal InterAgency Conference on Traumatic Brain Injury: Integrating Models of Research and Service Delivery” at Bethesda, Md, on March 11, 2006. The author thanks Dr Mitchell Rosenthal and the organizing committee for the invitation to speak at the conference. The support of the Charles A. Dana Foundation (WMC GCRC M01 RR00047) and the NIH-NINDS (grants NS02172 and NS43451) is acknowledged.