Alterations in white matter microstructure and glymphatic function in post-traumatic disorders of consciousness: impact on consciousness levels and prognosis

Purpose This study aimed to investigate the impairments in white matter microstructure and glymphatic function in patients with post-traumatic brain injury (TBI) who exhibit disorders of consciousness (DoCs), as well as their relationships with levels of consciousness and clinical outcomes. Methods We enrolled 30 patients diagnosed with TBI who exhibited DoCs and 30 healthy controls for MRI scanning. We compared intergroup differences in diffusion tensor imaging (DTI) metrics, the DTI analysis along the perivascular space (DTI-ALPS) index, and choroid plexus volume (CPV). The Pearson correlation analysis was conducted to examine the correlations among various indicators in the DoC group. Results Significant group differences were found in DTI metrics, the DTI-ALPS index, and CPV ( P < 0.05). In the DoC group at baseline, fractional anisotropy (FA) and mean diffusivity (MD) values correlated with Coma Recovery Scale-Revised, DTI-ALPS, and CPV ( P < 0.05). At 3-month follow-up, Glasgow Outcome Scale-Extended (scores were positively correlated with FA and DTI-ALPS, but negatively correlated with MD and CPV ( P < 0.05). Conclusion This study suggested that TBI may cause brain structural damage, impair glymphatic function, and subsequently affect patients’ levels of consciousness. These findings further indicate that glymphatic dysfunction could play an important role in the pathogenesis and prognosis of DoCs.