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Recovery of Injured Lower Portion of the Ascending Reticular Activating System in a Patient with Traumatic Brain Injury

Jang, Sung Ho, MD; Kim, Seong Ho, MD; Lim, Hyoung Won, PhD; Yeo, Sang Seok, PhD

American Journal of Physical Medicine & Rehabilitation: March 2015 - Volume 94 - Issue 3 - p 250–253
doi: 10.1097/PHM.0000000000000274
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ABSTRACT The authors report on a patient with traumatic brain injury who showed recovery of an injured lower portion of the ascending reticular activating system (ARAS) between the pontine reticular formation and the thalamus. A 57-yr-old male patient experienced head trauma. After 4 mos from onset, he exhibited impaired alertness, with a score of 7 on the Glasgow Coma Scale. At 40 mos after onset, the patient had a full Glasgow Coma Scale score of 15. The lower portion of the ARAS was reconstructed using the probabilistic tractography method. On 4-mo diffusion tensor tractography, the fractional anisotropy and the tract volume of the lower portion of the right ARAS were lower by more than 2 SDs of those of control subjects. By contrast, on 40-mo diffusion tensor tractography, the fractional anisotropy and the tract volume values of the lower portion of the right ARAS were within 2 SDs of those of the control subjects. The increment fractional anisotropy and the FV value of the lower portion of the right ARAS on 40-mo diffusion tensor tractography indicated recovery of the injured lower ARAS. As a result, recovery of an injured lower portion of the ARAS in a patient with traumatic brain injury was demonstrated.

From the Departments of Physical Medicine and Rehabilitation (SHJ) and Neurosurgery (SHK), College of Medicine, Yeungnam University, Taegu; and Department of Physical Therapy, College of Health Sciences, Dankook University, Cheonan-si, Chungnam, Republic of Korea (HWL, SSY).

All correspondence and requests for reprints should be addressed to: Sang Seok Yeo, PhD, Department of Physical Therapy, College of Health Sciences, Dankook University, 119, Dandae-ro, Dongnam-gu, Cheonan-si, Chungnam, 330-714, Republic of Korea.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.