Skip to main content
SpringerLink
Log in

Prognostication of Recovery of Consciousness in Patients in a Vegetative State Using Proton Magnetic Resonance Spectroscopy

  • Published:
Neuroscience and Behavioral Physiology Aims and scope Submit manuscript

Objectives. To study the predictive significance of proton magnetic resonance spectroscopy (MRS) in patients in a vegetative state. Materials and methods. Multivoxel MRS was carried out in 34 patients in a vegetative state with voxels in the thalamus, globus pallidus, putamen, internal capsule, fornix, brainstem, and the temporal and frontal areas of the cortex. Patients were divided into groups depending on the etiology of vegetative state: 22 patients had the sequelae of traumatic brain injury (TBI) and 12 patients had the sequelae of hypoxic brain damage. The groups were comparable in terms of age and the duration of the vegetative state (mean 2.3 months). Neurological status was assessed both during the hospitalization period and at 6–12 months using the Coma Recovery Scale (CRS-R). MRS results obtained at 6–12 months were compared with baseline data. The outcome of patients with the sequelae of TBI were as follows: persistent vegetative state in six patients, minimally conscious state plus in nine patients, recovery from the state of minimal consciousness in seven. Outcomes of patients with the sequelae of hypoxia were: persistent vegetative state in 10 patients and minimally conscious state plus in two. Results. Decreases in the N-acetylaspartate/creatinine ratio in the thalamus, internal capsule, and temporal cortex correlated with poor outcomes in both groups, while higher values correlated with further recovery of consciousness. Decreases in the N-acetylaspartate/creatinine ratio and the N-acetylaspartate/N-acetylaspartate + choline + creatine ratio in the midbrain correlated with poor outcomes only in patients with the sequelae of hypoxia. Conclusions. The results obtained here suggest that MRS provides a more accurate determination of the outcome in patients with hypoxic brain damage and patients with TBI, who showed recovery of consciousness to the level of coming out of the vegetative state.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. E. A. Kondrateva, I. A. Avdyunina, A. N. Kondratev, et al., “Identification of the signs of consciousness and prognostication of outcomes in patients in vegetative state,” Vestn. Ross. Akad. Med. Nauk, 71, No. 4, 273–280 (2016).

    Article  Google Scholar 

  2. I. V. Litvinenko, A. A. Yurin, A. Yu. Efi mtsev, et al., “New capacities of neuroimaging in traumatic brain injury,” Izv. Ross. Voenno-Med. Akad., 35, 24–28 (2016).

    Google Scholar 

  3. S. Laureys and M. Boly, “The changing spectrum of coma,” Nat. Clin. Pract. Neurol., 4, 544–546 (2008).

    Article  Google Scholar 

  4. M. A. Bruno, S. Majerus, M. Boly, et al., “Functional neuroanatomy underlying the clinical subcategorization of minimally conscious state patients,” J. Neurol., 259, No. 6, 1087–1098 (2012).

    Article  Google Scholar 

  5. A. Thibaut, M. A. Bruno, C. Chatelle, et al., “Metabolic activity in external and internal awareness networks in severely braindamaged patients,” J. Rehabil. Med., 44, No. 6, 487–494 (2012).

    Article  Google Scholar 

  6. H. Zhu and P. B. Barker, “MR spectroscopy and spectroscopic imaging of the brain,” Methods Mol. Biol., 711, No. 203–226 (2011).

  7. B. S. Li, H. Wang, and O. Gonen, “Metabolite ratios to assumed stable creatine level may confound the quantifi cation of proton brain MR spectroscopy,” Magn. Reson. Imaging, 21, No. 8, 923–928 (2003).

    Article  CAS  Google Scholar 

  8. M. Castillo, L. Kwock, and S. K. Mukherji, “Clinical applications of proton MR spectroscopy,” AJNR Am. J. Neuroradiol., 17, 1–15 (1996).

    CAS  PubMed  Google Scholar 

  9. K. M. Cecil, E. C. Hills, M. E. Sandel, et al., “Proton magnetic resonance spectroscopy for detection of axonal injury in the splenium of the corpus callosum of brain-injured patients,” J. Neurosurg., 88, 795–801 (1998).

    Article  CAS  Google Scholar 

  10. B. D. Ross, T. Ernst, R. Kreis, et al., “1H MRS in acute traumatic brain injury,” J. Magn. Reson. Imaging, 8, 829–840 (1998).

    Article  CAS  Google Scholar 

  11. M. R. Garnett, A. M. Blamire, R. G. Corkill, et al., “Early proton magnetic resonance spectroscopy in normal-appearing brain correlates with outcome in patients following traumatic brain injury,” Brain, 123, No. 10, 2046–2054 (2000).

    Article  Google Scholar 

  12. W. M. Brooks, C. A. Stidley, H. Petropoulos, et al., “Metabolic and cognitive response to human traumatic brain injury: a quantitative proton magnetic resonance study,” J. Neurotrauma, 17, 629–640 (2000).

    Article  CAS  Google Scholar 

  13. A. Carpentier, D. Galanaud, L. Puybasset, and J.-C. Muller, “Early morphologic and spectroscopic magnetic resonance in severe traumatic brain injuries can detect ‘invisible brain stem damage and predict vegetative states, ’”J. Neurotrauma, 23, No. 5, 674–685 (2006).

    Article  Google Scholar 

  14. S. Marino, E. Zei, M. Battaglini, et al., “Acute metabolic brain changes following traumatic brain injury and their relevance to clinical severity and outcome,” J Neurol. Neurosurg. Psychiatry, 78, 501–507 (2007).

    Article  Google Scholar 

  15. B. A. Holshouser, K. A. Tong, S. Ashwal, and U. Oyoyo, “Prospective longitudinal proton magnetic resonance spectroscopic imaging in adult traumatic brain injury,” J. Magn. Reson. Imaging, 24, No. 1, 33–40 (2006).

    Article  Google Scholar 

  16. E. Tollard, D. Galanaud, V. Perlbarg, et al., “Experience of diffusion tensor imaging and 1H spectroscopy for outcome prediction in severe traumatic brain injury: preliminary results,” Crit. Care Med., 37, 1448–1455 (2009).

    Article  Google Scholar 

  17. B. Y. Choe, T. S. Suh, K. H. Choi, et al., “Neuronal dysfunction in patients with closed head injury evaluated by in vivo 1H magnetic resonance spectroscopy,” Invest. Radiol., 30, No. 8, 502–550 (1995).

    Article  CAS  Google Scholar 

  18. D. J. Dubowitz, S. Bluml, E. Arcinue, and R. B. Dietrich, “MR of hypoxic encephalopathy in children after near drowning: Correlation with quantitative proton MR spectroscopy and clinical outcome,” Am. J. Neuroradiol., 19, No. 9, 1617–1627 (1998).

    CAS  PubMed  Google Scholar 

  19. M. Uzan, S. Albayram, S. G. Dashti, et al., “Thalamic proton magnetic resonance spectroscopy in vegetative state induced by traumatic brain injury,” J Neurol. Neurosurg. Psychiatry, 74, 33–38 (2003).

    Article  CAS  Google Scholar 

  20. L. Tshibanda, A. Vanhaudenhuyse, D. Galanaud, et al., “Magnetic resonance spectroscopy and diffusion tensor imaging in coma survivors: promises and pitfalls,” Prog. Brain Res., 177, No. 215–229 (2009).

    Article  Google Scholar 

  21. J. T. Giacino, K. Kalmar, and J. Whyte, “The JFK coma recovery scale-revised: measurement characteristics and diagnostic utility,” Arch. Phys. Med. Rehabil., 85, 2020–2029 (2004).

    Article  Google Scholar 

  22. E. G. Iazeva, L. A. Legostaeva, A. A. Zimin, et al., “A Russian validation study of the Coma Recovery Scale-Revised (CRS-R),” Brain Inj., 2, 1–8 (2018).

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Polenov Russian Research Neurosurgical Institute, Branch of the Almazov National Medical Research Center, Russian Ministry of Health, St. Petersburg, Russia

    E. A. Kondratyeva, S. A. Kondratyev, N. E. Ivanova & A. N. Kondratyev

  2. Medsi St. Petersburg, St. Petersburg, Russia

    S. V. Diment

  3. Almazov National Medical Research Center, Russian Ministry of Health, St. Petersburg, Russia

    T. A. Bukkieva, A. Yu. Efimtsev & G. E. Trufanov

  4. Coma Science Group University Clinic, Liège, Belgium

    S. Laurens

Authors
  1. E. A. Kondratyeva
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. V. Diment
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. A. Kondratyev
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. N. E. Ivanova
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T. A. Bukkieva
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Yu. Efimtsev
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. G. E. Trufanov
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. N. Kondratyev
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. S. Laurens
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E. A. Kondratyeva.

Additional information

Translated from Zhurnal Nevrologii i Psikhiatrii imeni S. S. Korsakova, Vol. 119, No. 10, Iss. 1, pp. 7–14, October, 2019.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kondratyeva, E.A., Diment, S.V., Kondratyev, S.A. et al. Prognostication of Recovery of Consciousness in Patients in a Vegetative State Using Proton Magnetic Resonance Spectroscopy. Neurosci Behav Physi 50, 817–824 (2020). https://doi.org/10.1007/s11055-020-00972-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11055-020-00972-5

Keywords

Search

Navigation