PMC10448513_01
PEDS-GCS and hospital day. In Case 1, the rs-fMRI most networks were not detected, and seizure networks (rs-SOZ+) were found, yet the EEG was without a seizure. After antiseizure treatment, the rs-SOZ resolved, and the resting state networks were normalized. The task-fMRI, which was initially negative, then showed command followed by network activation. Thus, he was determined to have cognitive motor dissociation. In Case 2, rs-SOZ was also positive, the EEG was without a seizure, and antiseizure medication was then given. However, this rs-fMRI did show networks that were otherwise normal, raising the concern for either cognitive motor dissociation or locked-in syndrome. At that time, he had facial movements of repetitive stereotyped grimacing that occurred with and without stimulus and were difficult to interpret, especially in relation to painful stimuli and prompts for commands. The task-fMRI service for DoC was not available. After recovery, the patient described being aware while in the ICU and unable to communicate. He said, "It was boring. I could see people walking in the hallway. When doctors came in the room to talk, then it was more interesting. I played choose your own adventure in my mind ".
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Figures 2, 3), which is often considered fatal. Furthermore, the patient experienced cardiac arrest.
Patient 1: (S1) T1W MRI with cervical level one atlanto-occipital dislocation (RED arrow) and same level spinal cord displacement with edema indicating severe spinal cord injury, often considered a fatal injury, not shown. Anatomical MRI otherwise showed patchy diffuse signs of diffuse axonal injury. (S2-S3) rs-SOZ with a red-blue activation-deactivation pattern and (S6A-B) fast frequencies in the BOLD power spectrum and time course. (S4-S5) Post-seizure treatment task-fMRI motor activation and normalized rs-fMRI motor network with (S7A-B) normal BOLD power spectrum and time course. The patient's motion during rs-fMRI was < 0.2 mm in any direction.
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Figures 2, 3), which is often considered fatal. Furthermore, the patient experienced cardiac arrest.
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Patient 2: (T1) T1W MRI AVM hemorrhage (RED arrow on right) within the cerebellum with resultant mass effect on the brainstem and anterior cerebellum (RED arrow on left) indicative of life-threatening injury and an indication for emergent posterior fossa craniectomy, which occurred after this image was acquired. Anatomical MRI otherwise showed patchy diffusion restriction in the brainstem, tegmentum, and cerebellum (not shown). (T2) rs-SOZ with (T6A-B) fast frequency in the BOLD power spectrum and time course. (T3-T5) Normal resting state networks of language, sensory-motor hand, and frontoparietal networks, with (T7A-B) normal BOLD power spectrum and time course. Images above are representative of the findings. Categorization of rs-fMRI networks in children with and without epilepsy is described. Normal neuronal BOLD has an oscillatory pattern that has <6 Hz/100, whereas cerebrospinal fluid pulsation-related noise has a faster regular cadence, and rs-SOZ has > 6 Hz/100. Artifacts have a spatial distribution that may not respect brain boundaries. Rs-SOZ is spatially largely over gray matter. The patient's motion during rs-fMRI was < 1 mm in any direction.
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An 11-year-old boy with a normal developmental history and no significant medical, social, or genetic background experienced a spontaneous rupture of a cerebellar vermian arteriovenous malformation (AVM) (Figure 4).
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Patient 3: Patient 3: (A1) No rs-fMRI networks, only artifact signal with (A2-A3) high-frequency power spectrum and regular cerebral spinal fluid-pulsation artifact time course, as expected in an infant who progressed to brain death shortly afterward. (B1-B3) Comparisons of neonate with normal resting state networks - shown are sensory-motor, language, and default modes, respectively. (B4-B5) A representative BOLD time course and normal power spectrum from the normal neonate's networks. The patient's motion during rs-fMRI was < 0.2 mm in any direction.
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On the first day, the patient's anatomical MRI was severely affected by movement artifacts, and purposeful-appearing movements were observed (Figure 5).