Case Reports Functional MR imaging assessment of a non-responsive brain injured patient Chad H. Moritz a, *, Howard A. Rowley a , Victor M. Haughton a , Karin R. Swartz b , John Jones c , Behnam Badie b a Department of Radiology, University of Wisconsin, Madison, WI, USA b Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA c Department of Neurology, University of Wisconsin, Madison, WI, USA Received 2 June 2001; accepted 15 August 2001 Abstract Functional magnetic resonance imaging (fMRI) was requested to assist in the evaluation of a comatose 38-year-old woman who had sustained multiple cerebral contusions from a motor vehicle accident. Previous electrophysiologic studies suggested absence of thalamo- cortical processing in response to median nerve stimulation. Whole-brain fMRI was performed utilizing visual, somatosensory, and auditory stimulation paradigms. Results demonstrated intact task-correlated sensory and cognitive blood oxygen level dependent (BOLD) hemo- dynamic response to stimuli. Electrodiagnostic studies were repeated and evoked potentials indicated supratentorial recovery in the cerebrum. At 3-months post trauma the patient had recovered many cognitive & sensorimotor functions, accurately reflecting the prognostic fMRI evaluation. These results indicate that fMRI examinations may provide a useful evaluation for brain function in non-responsive brain trauma patients. © 2001 Elsevier Science Inc. All rights reserved. Keywords: Electroencephalogram; Evoked potential; Magnetic resonance imaging; Traumatic brain injury; fMRI 1. Introduction With recent developments in life-sustaining techniques, organ removal for transplant, and “living will” guidelines, an accurate and timely prognostication of brain function and possible recovery for comatose patients becomes increas- ingly pertinent. Electrodiagnostic studies such as electroen- cephalography (EEG) and somatosensory evoked potentials (SSEP) are commonly applied for assessment of cerebral function in head injury patients. The sensitivity of these tests, however, can be influenced by factors such as scalp edema or hypothermia; factors which are commonly seen in trauma patients [1]. Although magnetic resonance (MR) imaging, MR angiography, and diffusion-weighted MR techniques have been applied in diagnosis of brain death [2–5], they have not been commonly used to assess brain function in a comatose patient. In this report we applied functional MR imaging techniques as a probe of brain function in a non-responsive brain trauma patient with ab- normal electrodiagnostic assessment. 2. Case Report The patient was a previously healthy 38-year-old woman who was struck by a motor vehicle and subsequently suf- fered severe multifocal contusions. Her initial Glasgow coma score was 11 (spontaneous eye opening, indistinct moaning, purposeful movement). She deteriorated over the next 72 hours, to the point of responding to painful stimuli only and requiring intubation. Intracranial pressure readings rose to the mid-fifties, and her course became complicated by apparent ischemic injury to both posterior cerebral artery distributions likely due to herniation. She underwent a de- compressive craniotomy and was started on thiopental to control her intracranial hypertension. The patient had given specific advanced directives that no extraordinary measures were to be taken in the event of “an unlikely neurological recovery.” To help with their decision making, her family requested further information * Corresponding author. Tel.: +1-608-262-4033; fax: +1-608-265- 9840. E-mail address: cmoritz@mail.radiology.wisc.edu (C.H. Moritz). Magnetic Resonance Imaging 19 (2001) 1129 –1132 0730-725X/01/$ – see front matter © 2001 Elsevier Science Inc. All rights reserved. PII: S0730-725X(01)00432-5