PREDICTION OF RECOVERY FROM POSTTRAUMATIC VEGETATIVE STATE WITH CEREBRAL MAGNETIC-RESONANCE-IMAGING

Background The early post-traumatic vegetative state (VS) is compatibl e with recovery. Various clinical and laboratory tests have failed to predict recovery so we assessed the value of cerebral magnetic-resonan ce imaging (MRI) in prediction of recovery. Methods 80 adult patients in post-traumatic VS had cerebral MRI between 6 weeks and 8 weeks afte r injury. MRIs were reviewed by three neuroradiologists for the number , sizes, and location of brain lesions. Three neurologists assessed th e patients at the time of MRI and at 2 months, 3 months, 6 months, 9 m onths, and 12 months after injury using the Glasgow Outcome Scale. Fin dings At 12 months, 38 patients had recovered while 42 patients remain ed in the VS. The demographic characteristics and causes and severity of injury were similar in patients in persistent VS (PVS) and those wh o recovered (NPVS). An average of 6.1 different brain areas were injur ed in patients in PVS compared with 4.6 areas in patients who had NPVS . Patients in PVS revealed a significantly higher frequency of corpus callosum, corona radiata, and dorsolateral brainstem injuries than did patients who recovered. Logistic regression analysis showed that corp us callosum and dorsolateral brainstem injuries were predictive of non -recovery. The adjusted odds ratios for non-recovery of patients with a corpus callosum lesion and dorsolateral brainstem injury were 213.8 (95% CI 14.2-3213.3), and 6.9 (1.1-42.9), respectively. In contrast, c linical characteristics, such as initial score on the Glasgow Coma Sca le, age, and pupillary abnormalities failed to predict recovery. Inter pretation Cerebral MRI findings in the subacute stage after head injur y can predict the outcome of the posttraumatic VS. Corpus callosum and dorsolateral brainstem lesions are highly significant in predicting n on-recovery.