Thalamocortical Connection Changes with Recovery of Impaired Consciousness in a Stroke Patient with Parietal Lobe Injury

A 52-year-old female patient underwent craniectomy and hematoma removal for a spontaneous intracerebral hemorrhage in the left parietal lobe, as well as intraventricular and subarachnoid hemorrhages (Fig. 1-A). Brain magnetic resonance images obtained three months after onset showed leukomalactic lesions in the left parieto-occipital lobes (Fig. 1-A). Initially, the patient was in a vegetative state with a Coma Recovery Scale-revised score of 11 (auditory function: 2, visual function: 4, motor function: 2, verbal function: 1, communication: 0, and arousal: 2) (1). Subsequently, she underwent comprehensive rehabilitation, which included neurotropic drug treatments (armodafinil, pramipexole, amantadine, levodopa, and baclofen) and physical and occupational therapies (including tilt table standing). In addition, transcranial direct current stimulation was administered by using a neuroConn DC-stimulator. The anode was placed on the left parietal lobe (centered on the supraparietal lobule) and the cathode was placed on the opposite supraorbital region. The transcranial direct current stimulation intensity was 2 mA and the duration was 20 minutes/session with one session/day and seven sessions/week. Repetitive transcranial magnetic stimulation using a MagPro stimulator was applied to mid-portion of the right intraparietal sulcus at a frequency of 10 Hz with an 80% motor threshold intensity and 160 pulses for 8 minutes/session with one session/day and seven sessions/week. After one month of rehabilitation, the patient had recovered to a nearly normal conscious state with a Coma Recovery Scale-revised score of 21 (auditory function: 4, visual function: 5, motor function: 5, verbal function: 2, communication: 2, arousal: 3) [1]. The patient’s sister provided signed, informed consent, and the study protocol was approved by our institutional review board.