Bund C, Roquet D, Noblet V, Schenck-Dhif M, Schneider F, Kremer S and Namer IJ
Background: Consciousness disorders in brain-injured patients are sometimes complicated to understand. The accuracy of the distinction between coma, vegetative state, minimally conscious state and locked-in syndrome can be improved by using functional imaging modalities, which is important because of the therapeutic impact.
Case presentation: We report a case of a 34 years old diabetic Caucasian woman whose glycemia had been previously tightly controlled with an insulin pump and who developed a profound coma overnight (spontaneous ventilation and Glasgow score 6) with transient ocular revulsions and intermittent crawling movements triggered by noxious stimuli at admission. At the 3rd day, 18F-fluorodeoxyglucose (FDG) PET and resting-state functional MRI (rs-fMRI) were performed when the patient spontaneously opened her eyes, but no evidence of awareness of the environment could be obtained. Awareness recovered progressively and follow-up imaging was performed on the 7th day when the patient presented only certain cognitive disorders. We demonstrated that rs-fMRI and FDG PET are non-invasive imaging tools that are helpful in the assessment of consciousness levels and residual cognitive disorders in patients with metabolic severe coma.