Functional Brain Imaging in the Clinical Assessment of Consciousness 英文参考文献.docVIP

Essay FunctionalBrainImagingintheClinicalAssessmentof Consciousness MichaelS.Rafii1,JamesB.Brewer1,2* 1DepartmentofNeurosciences,UniversityofCaliforniaSanDiego,SanDiego,California,UnitedStatesofAmerica,2DepartmentofRadiology,UniversityofCaliforniaSan Diego,UnitedStatesofAmerica Ihehospitalandthelone neurology residenthas just beencalled in on a case—a woman had found her 40- year-old husband unresponsive on the floor intheirlivingroom,after sheheard a loud thud. When she ran to see what happened and saw her husband lying motionless, she immediately called 911. She frantically administered chest com- pressions and forced breaths until the paramedicsarrivedandtookoverresusci- tation efforts. After detecting a pulse but almostnobloodpressure,theydelivereda large bolus of fluids intravenously and insertedanendotrachealtubetoventilate theman’slungs. weeks, or even months. Despite best efforts,nearly40%ofconsciousnessdisor- dersaremisdiagnosed[2].Inthesettingof suchinaccuracy,thepossibilityofapplying new technology toward this problem is clearlyenticing.Somehaveproposedthat functional magnetic resonance imaging (fMRI) might allow physicians to ‘‘look inside the brain’’ to identify conscious brain function. Recently, a group of researchers has successfully applied fMRI toidentifyconsciousnessinbrain-damaged individualsand,inonecase,tocommuni- catewiththepatient. sustaininginterventions.Neurologistshave longsoughtimprovedinsightintowhether ornotanindividualisconsciousandtools are needed for communicating with such individuals.Thus,recenthigh-profilefind- ings using fMRI have led to widespread interest in near-term application of this technology in the clinical arena, where patients thought to be without conscious- ness or ability to communicate would be scanned with fMRI to identify brain activation consistent with consciousness. Further, these findings have raised hope that volitional control of brain activation might provide a means by which such patientscouldco