C. Tommasino et al., REGIONAL CEREBRAL METABOLISM OF GLUCOSE IN COMATOSE AND VEGETATIVE STATE PATIENTS, Journal of neurosurgical anesthesiology, 7(2), 1995, pp. 109-116
Regional cerebral metabolism of glucose (rCMR(glu)) was evaluated in p
atients who were in a coma and vegetative state to determine the level
of brain function during these conditions. rCMR(glu) was measured in
17 discrete brain regions with 2-[F-18]-fluoro-2-deoxy-D-glucose (FDG)
and positron emission tomography (PET) in 15 patients with brain path
ology subsequent to cardiorespiratory arrest (CA), head trauma (HT), o
r brain ischemia (BI) resulting from cerebrovascular accident or brain
surgery. Five comatose patients (Coma group, n = 5), and 10 vegetativ
e state patients (VS, patients awake but not aware) were studied. The
VS patients were subdivided, according to the length of their VS condi
tion, into a VS group (n = 6, <3 months if CA or BI patients, or <12 m
onths if HT patients) and a persistent vegetative state group (PVS, n
= 4, >3 months if CA or BI patients or >12 months if HT patients). Ten
normal age-matched subjects served as control. Global CMR(glu) was 6.
72 +/- 0.93 (+/- SD) mg/100 g/min in control subjects. It was signific
antly (p less-than-or-equal-to 0.001) reduced to 3.70 +/- 61 in coma,
to 3.45 +/- 0.78 in VS, and to 2.33 +/- 0.34 mg/100 g/min in PVS patie
nts. rCMR(glu) was significantly reduced (p less-than-or-equal-to 0.00
1) from control values in all the 17 structures surveyed in every pati
ent. In the Coma and VS groups, there was an overlapping of rCMR(glu)
in the majority of the brain structures. The only significant differen
ce was in the occipital lobe, at level of the primary visual cortex, w
here a higher metabolic rate was found in VS patients (4.08 +/- 0.89 v
s. 3.79 +/- 0.63 mg/100 g/min, p less-than-or-equal-to 0.001). rCMR(gl
u) was maximally reduced in PVS patients (range, 50-72%), and the redu
ction was significantly lower than that of the Coma (range, 36-54%) an
d VS (range, 34-54%) groups in all the structures (p less-than-or-equa
l-to 0.001). Global, as well as rCMR(glu), did not correlate with clin
ical outcome, whereas younger age significantly correlated with recove
ry of consciousness.