Cerebral diffusion tensor imaging, awakening, consciousness recovery prognosis in comatose patients and physical and rehabilitation medicine: A case report

Summary Introduction Evolution of comatose patients can be made either towards a persistent vegetative state (or unresponsive wakefulness syndrome–UWS), minimally conscious state or a recovery of self and environment awareness. Investigations remain insufficient to estimate the prognosis and optimize the orientation and long-term follow-up of these patients in physical and rehabilitation medicine (PRM). Multimodal magnetic resonance imaging (MRI) are being evaluated for the diagnosis and prognosis of altered consciousness states [1] , [2] . Diffusion tensor imaging (DTI) could predict the mid-term evolution within a 95%-specificity. Case report A 29-years-old woman gives birth by vaginal delivery (pre-eclampsia) with the onset of a HELLP syndrome. At 4 A.M., comatose state (GCS: 3/5). TDM showed a parenchymal pontine and midbrain hematoma. No sign of awakening. The brain MRI (M3) showed atrophy (pons, midbrain, and middle cerebellar peduncles). DTI sequence with tractography shows a complete interruption of the left corticospinal tract as well as a rarefaction of inferior cerebellar peduncle fibers. The patient occasionally opens her eyes, without eye-tracking or other awakening sign (M10). The question then arises of the orientation of this patient in a persistent vegetative states unit and the future taking care by PRM team. Discussion DTI MRI with measure of anisotropy fraction could be a promising tool in order to predict the prognosis of altered conscious states and optimize the orientation and long-term follow-up of these patients in PRM.