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Relationship between regional cerebral metabolism and consciousness disturbance in traumatic diffuse brain injury without large focal lesions: an FDG-PET study with statistical parametric mapping analysis

¹ Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital, Minokamo City, Gifu
² Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital, Minokamo City, Gifu, Japan
³ Department of Neurosurgery, Gifu Prefectural Gifu Hospital, Gifu
⁴ Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu

Correspondence to:
Correspondence to:
Dr Noriyuki Nakayama
Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital, 630 Shimokobi, Kobi-cho, Minokamo City, Gifu 505-0034, Japan; doctor.1{at}jasmine.ocn.ne.jp

Background: The cerebral metabolism of patients in the chronic stage of traumatic diffuse brain injury (TDBI) has not been fully investigated.

Aim: To study the relationship between regional cerebral metabolism (rCM) and consciousness disturbance in patients with TDBI.

Methods: 52 patients with TDBI in the chronic stage without large focal lesions were enrolled, and rCM was evaluated by fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) with statistical parametric mapping (SPM). All the patients were found to have disturbed consciousness or cognitive function and were divided into the following three groups: group A (n = 22), patients in a state with higher brain dysfunction; group B (n = 13), patients in a minimally conscious state; and group C (n = 17), patients in a vegetative state. rCM patterns on FDG-PET among these groups were evaluated and compared with those of normal control subjects on statistical parametric maps.

Results: Hypometabolism was consistently indicated bilaterally in the medial prefrontal regions, the medial frontobasal regions, the cingulate gyrus and the thalamus. Hypometabolism in these regions was the most widespread and prominent in group C, and that in group B was more widespread and prominent than that in group A.

Conclusions: Bilateral hypometabolism in the medial prefrontal regions, the medial frontobasal regions, the cingulate gyrus and the thalamus may reflect the clinical deterioration of TDBI, which is due to functional and structural disconnections of neural networks rather than due to direct cerebral focal contusion.

Abbreviations: DAI, diffuse axonal injury; FDG-PET, fluorine-18-fluorodeoxyglucose positron emission tomography; rCM, regional cerebral metabolism; ROI, region of interest; SPM, statistical parametric mapping; TDBI, traumatic diffuse brain injury

Relevant Article

Evidence for white matter disruption in traumatic brain injury without macroscopic lesions

N Nakayama, A Okumura, J Shinoda, Y-T Yasokawa, K Miwa, S-I Yoshimura, and T Iwama
J. Neurol. Neurosurg. Psychiatry 2006 77: 850-855. [Abstract] [Full Text] [PDF]