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Functional MRI for Assessment of the Default Mode Network in Acute Brain Injury

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Abstract

Background

Assessment of the default mode network (DMN) using resting-state functional magnetic resonance imaging (fMRI) may improve assessment of the level of consciousness in chronic brain injury, and therefore, fMRI may also have prognostic value in acute brain injury. However, fMRI is much more challenging in critically ill patients because of cardiovascular vulnerability, intravenous sedation, and artificial ventilation.

Methods

Using resting-state fMRI, we investigated the DMN in a convenience sample of patients with acute brain injury admitted to the intensive care unit. The DMN was classified dichotomously into “normal” and “grossly abnormal.” Clinical outcome was assessed at 3 months.

Results

Seven patients with acute brain injury (4 females; median age 37 years [range 14–71 years]; 1 traumatic brain injury [TBI]; 6 non-TBI) were investigated by fMRI a median of 15 days after injury (range 5–25 days). Neurological presentation included 2 coma, 1 vegetative state/unresponsive wakefulness syndrome (VS/UWS), 3 minimal conscious state (MCS) minus, and 1 MCS plus. Clinical outcomes at 3 months included 1 death, 1 VS/UWS, 1 MCS plus, and 4 conscious states (CS; 1 modified Rankin Scale 0; 2 mRS 4; 1 mRS 5). Normal DMNs were seen in 4 out of 7 patients (1 MCS plus, 3 CS at follow-up).

Conclusions

It is feasible to assess the DMN by resting-state fMRI in patients with acute brain injury already in the very early period of intensive care unit admission. Although preliminary data, all patients with a preserved DMN regained consciousness levels at follow-up compatible with MCS+ or better.

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Author information

Author notes

  1. Kirsten Møller and Gitte Moos Knudsen have contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark

    Daniel Kondziella

  2. Neurobiology Research Unit, Copenhagen University Hospital and Center for Integrated Molecular Brain Imaging, Copenhagen, Denmark

    Patrick M. Fisher

  3. Department of Neuroradiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

    Vibeke Andrée Larsen

  4. Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

    John Hauerberg

  5. Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

    Martin Fabricius

  6. Department of Neuroanaesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

    Kirsten Møller

  7. Rigshospitalet and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Gitte Moos Knudsen

Authors
  1. Daniel Kondziella
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  2. Patrick M. Fisher
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  3. Vibeke Andrée Larsen
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  4. John Hauerberg
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  5. Martin Fabricius
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  6. Kirsten Møller
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  7. Gitte Moos Knudsen
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Corresponding author

Correspondence to Daniel Kondziella.

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Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Standard

All procedures performed were in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki declaration and its later amendments.

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Kondziella, D., Fisher, P.M., Larsen, V.A. et al. Functional MRI for Assessment of the Default Mode Network in Acute Brain Injury. Neurocrit Care 27, 401–406 (2017). https://doi.org/10.1007/s12028-017-0407-6

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  • DOI: https://doi.org/10.1007/s12028-017-0407-6

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