Jang Sung Ho, Seo Jeong Pyo
Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, South Korea.
Medicine (Baltimore). 2017 Feb;96(7):e6103. doi: 10.1097/MD.0000000000006103.
We report on restoration of the ascending reticular activating system (ARAS), compressed by an intracerebral hematoma and perihematomal edema following a stroke. The restoration of the ARAS was demonstrated by diffusion tensor tractography (DTT).
In a 60-year-old male, a brain MRI taken at 2 weeks after the surgery showed a hematoma and perihematomal edema in the left posterolateral pons and cerebellum, which were markedly resolved on a brain MRI after 5 weeks.
Intraventricular hemorrhage.
Navigation-guided stereotactic drainage of a hematoma in the left cerebellum, comprehensive rehabilitative therapy, including hypersomnia medication (modafinil), physical therapy, and occupational therapy.
His hypersomnia improved significantly with rehabilitation, with no daytime hypersomnia beginning 3 weeks after the surgery. On 2-week DTT, neither the neural tract of the left lower dorsal or ventral ARAS were reconstructed, but these neural tracts were wellreconstructed on 5-week DTT.
In conclusion, restoration of nonreconstructed neural tracts of the lower ARAS with the resolution of the hematoma and perihematomal edema was demonstrated in a stroke patient, using DTT.
我们报告了一名中风后因脑内血肿和血肿周围水肿而受压的网状激活系统（ARAS）的恢复情况。通过弥散张量纤维束成像（DTT）证实了ARAS的恢复。
一名60岁男性，术后2周的脑部MRI显示左后外侧脑桥和小脑有血肿及血肿周围水肿，5周后的脑部MRI显示这些情况明显消退。
脑室内出血。
导航引导下对左小脑血肿进行立体定向引流，进行综合康复治疗，包括使用治疗嗜睡的药物（莫达非尼）、物理治疗和职业治疗。
通过康复治疗，他的嗜睡症状明显改善，术后3周开始白天不再嗜睡。术后2周的DTT显示，左下部背侧或腹侧ARAS的神经束均未重建，但在术后5周的DTT上这些神经束重建良好。
总之，在一名中风患者中，利用DTT证实随着血肿和血肿周围水肿的消退，下部ARAS未重建的神经束得以恢复。
