Awake? Sleepy? In pain? Usually, we can tell another person’s state of being just by asking them.
But after a brain aneurysm ruptures, the normal methods aren’t reliable anymore.
A new paper by Senior Neurosurgery Resident Dr. Chuck Mikell aims to find out more about the differences between patients who can respond and those who can’t.
The award-winning paper, written under the mentorship of Dr. E. Sander Connolly, was published in the January issue of the journal Stroke. The authors hope that their results will help researchers find ways to improve patients’ outcomes after stroke.
Dr. Mikell realized that nobody knew the answer to an important question. Exactly which brain areas work in responsive patients but not in non-responsive patients?
To find out, he took functional MRI images of both responsive and non-responsive patients. Functional MRIs show in 3-D which brain areas are active as a person speaks, moves, listens, thinks, dreams, or carries out other activities.
He found that many networks at the front of the brain “lit up” in patients who were able to respond to commands. These networks were mainly in the frontal lobes, and included areas like the prefrontal cortex and the anterior cingulate gyrus, which are known to support attention and “high-level” executive function. In the unresponsive patients, these networks were quiet.
Dr, Mikell says the next step is to focus research on the frontal networks identified in this paper. “This advance will help in the design of new treatments,” explains Dr. Mikell. And Dr. Connolly agrees.
Using these results, he says, researchers may be able to “improve the outcomes from coma.” For example, they may identify new therapies or medications that can target the functionally important areas.
Visit the Cerebrovascular Lab home page to read about one drug, tiopronin, they are working on now. It’s a drug for kidney stones that can also reduce inflammation and cell death in the brain after stroke.
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