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背景意识障碍的鉴别诊断富有挑战性,误诊率约为40%,需要新的诊断方法来补充床旁检查,尤其是病人表现出意识行为体征能力减退时。方法在英国剑桥、比利时列日两个大型转诊中心,完成了54例意识障碍病人研究。我们采用功能性MRI评估每例病人,即完成两项精神意象任务时,产生的意向、神经解剖学特性、血氧水平依赖反应能力。所开发新技术用以确定完成此类任务时,能否用是或不是回答简单问题的方式做交流。结果纳入研究的54例病人,有5例能有意识地调节大脑活动。其中3例,床旁检查显示有些意识体征,但其余2例,临床评估方法未测出自发行为。做功能性MRI,1例病人能用是或不是回答问题;不过,不能建立任何形式的床旁交流。结论这些结果提示,少部分呈植物状态或有轻微意识病人,大脑活动反应出有些意识和认知存在。仔细的临床检查有利于对此类某些病人的意识状态重新类别。此技术有助于与无反应病人建立基础交流。
The differential diagnosis of background disorder is challenging, with a misdiagnosis rate of about 40%. New diagnostic methods are needed to complement the bedside examination, especially if the patient demonstrates diminished capacity for signs of conscious behavior. Methods In the two major referral centers in Cambridge, England and Liege, Belgium, 54 cases of patients with cognitive impairment were completed. We used functional MRI to evaluate each patient, the intent, neuroanatomical properties, and blood oxygen level-dependent responsiveness of the two mental image tasks. New technologies have been developed to determine the ways in which such tasks can be accomplished with or without answering simple questions. Results Of 54 patients enrolled in the study, 5 were able to consciously regulate brain activity. In 3 cases, the bedside examination showed some signs of consciousness, but the remaining 2 cases, no clinical evaluation of spontaneous behavior. To do functional MRI, one patient can or can not answer the question; however, no bedside communication can be established. Conclusions These results suggest that brain activity reflects some conscious and cognitive presence in a small proportion of patients with vegetative or lightly conscious patients. Careful clinical examination facilitates the reclassification of the state of consciousness of some of these patients. This technique helps establish basic communication with nonresponders.