RECOVERY of neurological impairments in COVID-19 remains an area of emerging understanding, but a recent case report described the role of resting-state functional MRI (rs-fMRI) in predicting recovery. Functional MRI has become an important tool in determining impairment and chance of recovery in states of altered consciousness.
A 47-year-old male patient fluctuated between coma and minimal consciousness for several weeks following respiratory failure caused by severe COVID-19. Despite profound clinical and structural neurological impairments, rs-fMRI revealed strong functional connectivity within the default mode network; this connectivity was similar to that seen in healthy patients. Other research has revealed that better default mode network connectivity predicts better neurologic recovery in disorders of consciousness. The findings in this case suggested a potential for a more positive prognosis than was otherwise evident.
After 61 days in hospital, neurological improvement was noted as the patient began to follow verbal commands, with further improvements seen over the following days. Dr David Fisher, Massachusetts General Hospital, Boston, Massachusetts, USA, described the use of rs-fMRI for prognostication in this case: “As neurologists, we were asked by many families whether their loved ones would regain consciousness, a critical question given that decisions about life support often hinged on the answer, but we were uncertain. We used functional MRI to try to provide a more comprehensive assessment of brain function.”
“Because there are so many unanswered questions about the potential for recovery in unresponsive patients who have survived severe COVID-19, any available data that could inform prognosis are critical,” said Dr Brian Edlow, Laboratory for Neuroimaging of Coma and Consciousness, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital. “Our unexpected observations do not prove that functional MRI predicts outcomes in these patients, but they suggest that clinicians should consider the possibility that unresponsive survivors of severe COVID-19 may have intact brain networks. We should thus exercise caution before presuming a poor neurologic outcome based on our conventional tests.”