The relationship between consciousness and the ascending reticular activating system in patients with traumatic brain in
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RESEARCH ARTICLE
Open Access
The relationship between consciousness and the ascending reticular activating system in patients with traumatic brain injury Sung Ho Jang and Young Hyeon Kwon*
Abstract Background: We investigated the relationship between consciousness and the ascending reticular activating system (ARAS) by using diffusion tensor tractography (DTT) in patients with traumatic brain injury (TBI). Methods: Twenty-six patients with TBI and 13 healthy control subjects were recruited for this study. Glasgow Coma Scale (GCS) scores were used for evaluation of subject consciousness state at the chronic stage of TBI (at DTT scanning), According to the GCS score, the patient group was divided into two subgroups: A (14 patients;impaired consciousness: GCS score < 15, and B (12 patients;intact consciousness;GCS score = 15). Fractional anisotropy (FA) and tract volume (TV) values were assessed in the lower dorsal and upper ARAS. Results: The FA values of the lower dorsal ARAS and the upper ARAS in patient subgroup A were significantly lower than those in patient subgroup B and the control group(p < 0.05). However, the FA and TV values for the lower dorsal ARAS and the upper ARAS were not significantly different between patient subgroup B and the control group(p > 0.05). The FA value of the lower dorsal ARAS(r = 0.473,p < 0.05) and the TV of upper ARAS(r = 0.484,p < 0.05) had moderate positive correlations with the GCS score. The FA value of the upper ARAS had a strong positive correlation with the GCS score of the patient group(r = 0.780,p < 0.05). Conclusions: We detected a close relationship between consciousness at the chronic stage of TBI and injuries of the lower dorsal and upper ARAS (especially, the upper ARAS) in patients who showed impaired consciousness at the onset of TBI. We believe that our results can be useful during the development of therapeutic strategies for patients with impaired consciousness following TBI. Trial registration: YUMC 2019–06–032-003. Retrospectively registered 06 Jun 2020. Keywords: Consciousness, Ascending reticular activating system, Traumatic brain injury, Diffusion tensor tractography, Glasgow coma scale
Background Traumatic brain injury (TBI) is a major cause of neurological disability in adults [1, 2]. Impaired consciousness is a common and serious sequela following TBI, and it has been reported that approximately half of patients in * Correspondence: [email protected] Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University 317-1, Daemyungdong, Namku, Taegu 705-717, Republic of Korea
a vegetative state at 1 month after TBI remain in the vegetative state until 1 year after onset [1, 2]. Therefore, research on the relation between consciousness and the neural structures that are related to consciousness in TBI is important in terms of the development of appropriate therapeutic strategies and for prognosis prediction. With regard to this field of research, little is known although a few studies have reported that there are relationshi
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