One of the major challenges for clinicians who treat patients with Disorders of Consciousness (DoCs) concerns the detection of signs of consciousness that distinguish patients in Vegetative State from those in Minimally Conscious State. Recent studies showed how visual responses to tailored stimuli are one of the first evidence revealing that one patient is changing from one state to another. This study aimed to explore the integrity of the neural structures being part of the visual system in patients with DoCs manifesting a reflexive behavior (visual blink) and in those manifesting a cognitively and cortically mediated behavior (visual pursuit). We collected instrumental data using specialized equipment (EEG following the rules of the International 10–20 system, 3T Magnetic Resonance, and Positron Emission Tomography) in 54 DoC patients. Our results indicated that visual pursuit group showed a better fVEPs response than the visual blink group, because of a greater area under the N2/P2 component of fVEPs (AUC could be seen as an indicator of the residual activity of visual areas). Considering neuroimaging data, the main structural differences between groups were found in the retrochiasmatic areas, specifically in the right optic radiation and visual cortex (V1), areas statistically less impaired in patients able to perform a visual pursuit. FDG‐PET analysis confirmed difference between groups at the level of the right calcarine cortex and neighboring right lingual gyrus. In conclusion, although there are methodological and theoretical limitations that should be considered, our study suggests a new perspective to consider for a future diagnostic protocol.

中文翻译：

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意识障碍中的视觉行为：通过多模式方法解开有意识的视觉处理。

治疗患有意识障碍（DoC）的患者的临床医生面临的主要挑战之一是检测意识状态的迹象，以区分植物性状态患者和最小意识状态的患者。最近的研究表明，对定制刺激的视觉反应是最早揭示一个患者正在从一种状态转变为另一种状态的证据之一。这项研究旨在探讨表现出自反行为（视觉眨眼）和表现出认知和皮质介导的行为（视觉追求）的DoC患者的视觉系统中神经系统的完整性。我们使用专用设备（遵循国际10-20系统，3T磁共振和正电子发射断层扫描的规则的EEG）收集了54名DoC患者的仪器数据。我们的结果表明，视觉追踪组比眨眼组表现出更好的fVEPs反应，这是因为fVEPs的N2 / P2成分下的面积更大（AUC可以看作是视觉区域残留活性的指标）。考虑到神经影像学数据，两组之间的主要结构差异是在后视交叉区域，特别是在右视辐射和视皮层（V1），在能够进行视觉追踪的患者中统计上受损较小的区域。FDG-PET分析证实了右钙肌皮层和相邻右舌回的水平之间存在差异。总之，尽管应该考虑方法和理论上的局限性，但我们的研究提出了考虑未来诊断方案的新观点。