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Metabolic activity in external and internal awareness networks in severely brain-damaged patients.
[locked-in syndrome]
An
extrinsic
cerebral
network
(
encompassing
lateral
frontoparietal
cortices
)
related
to
external
/
sensory
awareness
and
an
intrinsic
midline
network
related
to
internal
/
self-awareness
have
been
identified
recently
.
This
study
measured
brain
metabolism
in
both
networks
in
patients
with
severe
brain
damage
.
Prospective
[
18
F
]
-
fluorodeoxyglucose-positron
emission
tomography
and
Coma
Recovery
Scale-
Revised
assessments
in
a
university
hospital
setting
.
Healthy
volunteers
and
patients
in
vegetative
state
/
unresponsive
wakefulness
syndrome
(
VS
/
UWS
)
,
minimally
conscious
state
(
MCS
)
,
emergence
from
MCS
(
EMCS
)
,
and
locked-
in
syndrome
(
LIS
)
.
A
total
of
70
patients
were
included
in
the
study
:
24
VS
/
UWS
,
28
MCS
,
10
EMCS
,
8
LIS
and
39
age-matched
controls
.
VS
/
UWS
showed
metabolic
dysfunction
in
extrinsic
and
intrinsic
networks
and
thalami
.
MCS
showed
dysfunction
mostly
in
intrinsic
network
and
thalami
.
EMCS
showed
impairment
in
posterior
cingulate
/
retrosplenial
cortices
.
LIS
showed
dysfunction
only
in
infratentorial
regions
.
Coma
Recovery
Scale-
Revised
total
scores
correlated
with
metabolic
activity
in
both
extrinsic
and
part
of
the
intrinsic
network
and
thalami
.
Progressive
recovery
of
extrinsic
and
intrinsic
awareness
network
activity
was
observed
in
severely
brain
-damaged
patients
,
ranging
from
VS
/
UWS
,
MCS
,
EMCS
to
LIS
.
The
predominance
of
intrinsic
network
impairment
in
MCS
could
reflect
altered
internal
/
self-awareness
in
these
patients
,
which
is
difficult
to
quantify
at
the
bedside
.
Diseases
Validation
Diseases presenting
"external/sensory"
symptom
locked-in syndrome
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