Coma and cerebral imaging - PubMed (original) (raw)

Coma and cerebral imaging

Walter F Haupt et al. Springerplus. 2015.

Abstract

The clinical sign of coma is a common feature in critical care medicine. However, little information has been put forth on the correlations between coma and cerebral imaging methods. The purpose of the article is to compile the available information derived from various imaging methods and placing it in a context of clinical knowledge of coma and related states. The definition of coma and the cerebral structures responsible for consciousness are described; the mechanisms of cerebral lesions leading to impaired consciousness and coma are explained. Cerebral imaging methods provide a large array of information on the structural changes of brain tissue in the various diseases leading to coma. Circumscript lesions produce space-occupying masses that displace the brain, ultimately leading to various types of herniation. Generalized disease of the brain usually leads to diffuse brain swelling which also can cause herniation. Epileptic states, however, rarely are detectable by imaging methods and mandate EEG examinations. Another important aspect of imaging in coma is the increasing use of functional imaging methods, which can detect the function of loss of function in various areas of the brain and render information on the extent and severity of brain damage as well as on the prognosis of disease. The MRI methods of (1)H-spectroscopy and diffusion tensor imaging may provide more functional information in the future.

Keywords: Brain death; Brain disease; Coma; Computed tomography (CT); Functional Magnetic Resonance Imaging (fMRI); Magnetic Resonance Imaging (MRI).

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Figures

Figure 1

Figure 1

68 year- old patient with bilateral embolic thalamic infarctions causing coma.

Figure 2

Figure 2

90 year-old patient with thrombosis of inner veins, causing bilateral thalamic and basal ganglia edema, resulting in coma.

Figure 3

Figure 3

45 year-old patient with coma and lymphocytic pleocytosis in CSF, caused by immune-mediated encephalitis.

Figure 4

Figure 4

26 y/o patient with traumatic brain injury. A. CT scan only shows impression fracture and mild swelling. B. MRI shows severe contusion of right temporal lobe and bilateral mesencephalic lesions causing coma.

Figure 5

Figure 5

16 y/o patient with traumatic brain injury. A. CT shows no lesion. B. MRI shows multiple disseminated microbleeds in the T2* sequences.

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