Jang Sung Ho, Hyun Yi Ji, Lee Han Do
aDepartment of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu, Republic of Korea, bThe Department of Diagnostic Radiology, College of Medicine, Yeungnam University, Taegu, Republic of Korea.
Medicine (Baltimore). 2016 Jun;95(26):e4041. doi: 10.1097/MD.0000000000004041.
We report on a patient who survived cardiac arrest and showed recovery of consciousness and an injured ARAS at the early stage of hypoxic-ischemic brain injury (HI- BI) for 3 weeks, which was demonstrated by diffusion tensor tractography (DTT).A 52-year-old male patient who had suffered cardiac arrest caused by acute coronary syndrome was resuscitated immediately by a layman and paramedics for ∼25 minutes. He was then transferred immediately to the emergency room of a local medical center. When starting rehabilitation at 2 weeks after onset, his consciousness was impaired, with a Glasgow Coma Scale (GCS) score of 8 and Coma Recovery Scale-Revised (GRS-R) score of 8. He underwent comprehensive rehabilitative therapy, including drugs for recovery of consciousness. He recovered well and rapidly so that his consciousness had recovered to full scores in terms of GCS:15 and GRS-R:23 at 5 weeks after onset.The left lower dorsal and right lower ventral ARAS had become thicker on 5-week DTT compared with 2-week DTT (Fig. 1B). Regarding the change of neural connectivity of the thalamic ILN, increased neural connectivity to the basal forebrain and prefrontal cortex was observed in both hemispheres on 5-week DTT compared with 2-week DTT.Recovery of an injured ARAS was demonstrated in a patient who survived cardiac arrest and his consciousness showed rapid and good recovery for 3 weeks at the early stage of HI-BI.
我们报告了一名心脏骤停后存活的患者，其在缺氧缺血性脑损伤（HI-BI）早期意识恢复，且3周内受损的觉醒激活系统（ARAS）恢复，这通过弥散张量纤维束成像（DTT）得以证实。一名52岁男性患者因急性冠状动脉综合征导致心脏骤停，由一名外行人及护理人员立即进行了约25分钟的心肺复苏。随后他被立即转至当地医疗中心的急诊室。发病2周开始康复治疗时，他意识受损，格拉斯哥昏迷量表（GCS）评分为8分，昏迷恢复量表修订版（CRS-R）评分为8分。他接受了包括促醒药物在内的综合康复治疗。他恢复良好且迅速，发病5周时意识在GCS方面恢复至满分15分，在CRS-R方面恢复至满分23分。与2周时的DTT相比，5周时的DTT显示左下背侧和右下腹侧ARAS变厚（图1B）。关于丘脑板内核（ILN）神经连接性的变化，与2周时的DTT相比，5周时的DTT显示双侧半球与基底前脑和前额叶皮质的神经连接性增加。一名心脏骤停后存活的患者在HI-BI早期其受损的ARAS恢复，且其意识在3周内迅速且良好地恢复。
