Jang Sung Ho, Yeo Sang Seok
Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Gyeongsangbuk-do Department of Physical Therapy, College of Health Sciences, Dankook University, Cheonan-si, Chungnam, Republic of Korea.
Medicine (Baltimore). 2016 Dec;95(50):e5527. doi: 10.1097/MD.0000000000005527.
Many studies have reported about injury of the ascending reticular activating system (ARAS) in patients with various brain pathologies, using diffusion tensor tractography (DTT); however, little is known about injury of the ARAS in patients with pontine hemorrhage. In this study, using DTT, we attempted to investigate injury of the lower ventral and dorsal ARAS in patients with pontine hemorrhage. Twenty-three consecutive patients with pontine hemorrhage and 14 control subjects were recruited into this study. The patients were classified into 2 subgroups on the basis of the preservation of arousal: subgroup A (14 patients)-intact arousal, subgroup B (9 patients)-impaired arousal. The lower ventral and dorsal ARAS between the pontine reticular formation with hypothalamus and thalamic intralaminar nucleus were reconstructed. Fractional anisotropy (FA), mean diffusivity (MD), and tract volume (TV) values were measured. The TVs of the lower ventral and dorsal ARAS were significantly lower in subgroup B than in the subgroup A and control group (P < 0.05). In terms of FA value, the lower dorsal ARAS were significantly lower in subgroup A and subgroup B than in the control group (P < 0.05). In conclusion, injury of the lower ventral and dorsal ARAS was demonstrated in patients with impaired arousal following pontine hemorrhage. We believe that analysis of the ARAS using DTT would be helpful in evaluation of patients with impaired consciousness after pontine hemorrhage.
许多研究已报道了使用弥散张量纤维束成像（DTT）对患有各种脑部病变患者的上行网状激活系统（ARAS）损伤情况；然而，关于桥脑出血患者的ARAS损伤情况却知之甚少。在本研究中，我们使用DTT试图研究桥脑出血患者的腹侧和背侧下部ARAS损伤情况。本研究纳入了23例连续的桥脑出血患者和14名对照受试者。根据觉醒状态的保留情况将患者分为2个亚组：A亚组（14例患者）——觉醒正常，B亚组（9例患者）——觉醒受损。重建脑桥网状结构与下丘脑和丘脑板内核之间的腹侧和背侧下部ARAS。测量了分数各向异性（FA）、平均扩散率（MD）和纤维束体积（TV）值。B亚组腹侧和背侧下部ARAS的TV值显著低于A亚组和对照组（P<0.05）。就FA值而言，A亚组和B亚组背侧下部ARAS的FA值均显著低于对照组（P<0.05）。总之，桥脑出血后觉醒受损患者存在腹侧和背侧下部ARAS损伤。我们认为，使用DTT分析ARAS将有助于评估桥脑出血后意识障碍患者。
