{"doi":"10.1093/braincomms/fcaf439","title":"Different diseases, same circuits: lessons from rare and overlooked causes of disorders of consciousness","abstract":"Most foundational frameworks for understanding disorders of consciousness are based on common aetiologies such as traumatic brain injury, stroke or hypoxic-ischemic insult. From these, the mesocircuit hypothesis has emerged as a leading model, proposing that consciousness depends on a distributed network of brainstem arousal systems, central thalamic hubs and cortico-subcortical loops. However, rare and underrecognized causes of coma and prolonged disorders of consciousness offer a unique opportunity to test, refine and expand these models. In this review, we analyse a wide array of rare aetiologies-including genetic syndromes, parasitic and fungal infections, autoimmune encephalitides, amyloid and tau pathologies, toxic-metabolic states and haematological disorders-that are often excluded from mainstream consciousness research. Despite their diverse mechanisms, these conditions converge on a consistent set of anatomical targets: the central thalamus, brainstem reticular activating system, deep white matter 'bridging zones', basal ganglia and distributed cortical networks. This convergence not only provides powerful external validation of network-based frameworks such as the mesocircuit hypothesis but also underscores the clinical need for therapeutic approaches that address both aetiology-specific pathology and distributed circuit-level dysfunction. However, evidence quality varies considerably across these rare conditions, with many findings based on limited case reports or small series, necessitating cautious interpretation of proposed anatomical frameworks.","journal":"Brain Communications","year":2025,"id":548907,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9519,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":337518,"name":"Martin M. Monti","orcid":"0000-0001-5511-3780","position":1,"is_corresponding":false},{"id":623419,"name":"Daniel Toker","orcid":"0000-0003-0983-8937","position":0,"is_corresponding":true}],"reference_count":203,"raw_metadata":null,"created_at":"2026-07-19T02:54:03.053965Z","pmid":"41306818","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}