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For example, brainstem lesions causing coma map to a specific region of the tegmentum. Whether specific lesion locations outside the brainstem are associated with loss of consciousness (LOC) remains unclear. Here, we investigate the topography of cortical lesions causing prolonged LOC (<jats:italic>N<\/jats:italic>=\u200916), transient LOC (<jats:italic>N<\/jats:italic>=\u200991), or no LOC (<jats:italic>N<\/jats:italic>=\u200964). Using standard voxel lesion symptom mapping, no focus of brain damage was associated with LOC. Next, we computed the network of brain regions functionally connected to each lesion location using a large normative connectome dataset (<jats:italic>N<\/jats:italic>=\u20091,000). This technique, termed lesion network mapping, can test whether lesions causing LOC map to a connected brain circuit rather than one brain region. Connectivity between cortical lesion locations and an a priori coma\u2010specific region of brainstem tegmentum was an independent predictor of LOC (<jats:italic>B<\/jats:italic>=\u20091.2,<jats:italic>p<\/jats:italic>=\u2009.004). Connectivity to the dorsal brainstem was the only predictor of LOC in a whole\u2010brain voxel\u2010wise analysis. This relationship was driven by anticorrelation (negative correlation) between lesion locations and the dorsal brainstem. The map of regions anticorrelated to the dorsal brainstem thus defines a distributed brain circuit that, when damaged, is most likely to cause LOC. This circuit showed a slight posterior predominance and had peaks in the bilateral claustrum. Our results suggest that cortical lesions causing LOC map to a connected brain circuit, linking cortical lesions that disrupt consciousness to brainstem sites that maintain arousal.<\/jats:p>","DOI":"10.1002\/hbm.24892","type":"journal-article","created":{"date-parts":[[2020,1,6]],"date-time":"2020-01-06T14:42:53Z","timestamp":1578321773000},"page":"1520-1531","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":69,"title":["Cortical lesions causing loss of consciousness are anticorrelated with the dorsal brainstem"],"prefix":"10.1002","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6965-7890","authenticated-orcid":false,"given":"Samuel B.","family":"Snider","sequence":"first","affiliation":[{"name":"Departments of Neurology, Massachusetts General Hospital and Brigham and Women's Hospital Harvard Medical School Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joey","family":"Hsu","sequence":"additional","affiliation":[{"name":"Berenson\u2010Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology Beth Israel Deaconess Medical Center Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. Ryan","family":"Darby","sequence":"additional","affiliation":[{"name":"Department of Neurology Vanderbilt University Medical Center Nashville Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Cooke","sequence":"additional","affiliation":[{"name":"Berenson\u2010Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology Beth Israel Deaconess Medical Center Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Fischer","sequence":"additional","affiliation":[{"name":"Departments of Neurology, Massachusetts General Hospital and Brigham and Women's Hospital Harvard Medical School Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander L.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Berenson\u2010Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology Beth Israel Deaconess Medical Center Boston Massachusetts"},{"name":"Department of Neurology Boston Children's Hospital, Harvard Medical School Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan H.","family":"Grafman","sequence":"additional","affiliation":[{"name":"Rehabilitation Institute of Chicago Chicago Illinois"},{"name":"Department of Physical Medicine and Rehabilitation, Neurology, Cognitive Neurology and Alzheimer's Center, Department of Psychiatry, Feinberg School of Medicine and Department of Psychology, Weinberg College of Arts and Sciences Northwestern University Chicago Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D.","family":"Fox","sequence":"additional","affiliation":[{"name":"Berenson\u2010Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology Beth Israel Deaconess Medical Center Boston Massachusetts"},{"name":"Department of Neurology, Massachusetts General Hospital Harvard Medical School Boston Massachusetts"},{"name":"Athinoula A. 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