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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.
GLOSSARY
- AI=
- anterior insula;
- ARAS=
- ascending reticular activating system;
- MCS=
- minimally conscious state;
- pACC=
- pregenual anterior cingulate cortex;
- rs-fcMRI=
- resting-state functional connectivity MRI;
- VEN=
- von Economo neuron;
- VS/UWS=
- vegetative state/unresponsive wakefulness syndrome
Footnotes
↵* These authors contributed equally to this work.
↵‡ These authors contributed equally to this work.
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
- Received April 13, 2016.
- Accepted in final form September 6, 2016.
- © 2016 American Academy of Neurology
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