微意识状态患者视觉脑皮层活动的功能磁共振研究

Functional magnetic imaging of brain cortical activities in minimally conscious patients stimulated by visual presentation

目的探讨微意识状态患者是否保存大范围的视觉神经网络,是否存在视觉意识,从而研究视觉图片被动呈现刺激促进脑功能康复的可能性。方法正常对照组为10例健康成年男性,实验组为从重型颅脑损伤和脑出血中恢复的微意识患者9例;对两组对象选取标准化国际情感图片系统(IAPS)图片,采用组块设计被动呈现视觉刺激功能磁共振扫描,AFNI 软件处理图像数据。结果10例正常对照志愿者全部被激活了初级视觉皮层枕叶和次级视觉相关皮层颞叶、梭回、顶叶、眶回、前额叶等完整的视觉神经网络。微意识患者组中有2例与对照组相似完整地激活了视觉神经网络。3例患者部分激活了视觉神经网络的相关区域,4例完全无脑区激活。结论 IAPS 图片的被动呈现视觉刺激功能磁共振扫描探讨视觉神经网络是可行的、可靠的和具有良好的重复性。微意识患者在恢复相互交流能力之前,可保留有完整的视觉神经网络,可能有利于脑功能的康复。

Objective To investigate whether a large-scale visual network and visual consciousness are still retained in the patients with minimally conscious state （MCT） and the possibility of promoting the rehabilitation of brain function by visual stimulation. Methods Fifteen standardized pictures provided by the International Affective Picture System （IAPS2005） were passively presented to 10 normal adult controls and 9 patients in MCT recovering from severe craniocerebral injury or cerebral hemorrhage. Functional magnetic imaging was conducted. The AFNI software was used to process the ＂images thus collected. Results The primary visual cortex, occipital lobe, and the secondary visual cortexes, including temporal lobe, parietal lobe, fusiform gyrus, orbital gyrus, and prefrontal lobe were all activated in the 10 normal persons. Similar visual activation was found in 2 of the patients in MCS, however, with a smaller activation volume. Activation of partial visual network was found in 3 patients and the other 4 failed to be activated. Conclusion It is feasible to promote the rehabilitation of brain function by visual stimulation in the patients in MCS.