A human brain network derived from coma-causing brainstem lesions.

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.

journal_name

Neurology

journal_title

Neurology

authors

Fischer DB,Boes AD,Demertzi A,Evrard HC,Laureys S,Edlow BL,Liu H,Saper CB,Pascual-Leone A,Fox MD,Geerling JC

doi

10.1212/WNL.0000000000003404

subject

Has Abstract

pub_date

2016-12-06 00:00:00

pages

2427-2434

issue

23

eissn

0028-3878

issn

1526-632X

pii

WNL.0000000000003404

journal_volume

87

pub_type

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