Kwak Soyoung, Chang Min Cheol
Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 170 Hyunchung-ro, Namgu, Daegu, 42415, Republic of Korea.
Transl Neurosci. 2020 Aug 24;11(1):264-268. doi: 10.1515/tnsci-2020-0138. eCollection 2020.
The ascending reticular activating system (ARAS) is known to play an essential role in maintaining arousal and consciousness. In this report, we describe the case of a patient with impaired consciousness due to injury of the ARAS after bilateral pontine infarction. A 73-year-old female patient presented with anterior chest pain to the Emergency Department of our university hospital. She was diagnosed with chronic stable angina pectoris, three-vessel disease, and chronic total occlusion of the left anterior descending artery by coronary angiography and received conservative treatment. After five days, she showed deep drowsy mentality and brain MRI revealed bilateral paramedian pontine infarction. Four weeks after the pontine infarction, she showed severely impaired consciousness, with a Glasgow Coma Scale score of 7 (eye-opening: 2, best verbal response: 2, and best motor response: 3). Coma Recovery Scale-Revised score was 10 (auditory function: 2, visual function: 3, motor function: 2, verbal function: 2, communication: 0, and arousal: 1). Results of diffusion tensor tractography (DTT) for the ARAS showed decreased neural connectivity in the left lower dorsal ARAS, both lower ventral ARAS, and both upper ARAS. To the best of our knowledge, this is the first report of injury to the ARAS in bilateral pontine infarction diagnosed by DTT. We presume that our report would provide clinicians a better understanding of the mechanism of impaired consciousness in patients with pontine infarction.
已知上行网状激活系统（ARAS）在维持觉醒和意识方面起着至关重要的作用。在本报告中，我们描述了一例双侧脑桥梗死后因ARAS损伤导致意识障碍的患者病例。一名73岁女性患者因前胸疼痛到我校医院急诊科就诊。通过冠状动脉造影，她被诊断为慢性稳定型心绞痛、三支血管病变以及左前降支慢性完全闭塞，并接受了保守治疗。五天后，她出现深度嗜睡状态，脑部磁共振成像（MRI）显示双侧脑桥旁正中梗死。脑桥梗死后四周，她的意识严重受损，格拉斯哥昏迷量表评分为7分（睁眼：2分，最佳言语反应：2分，最佳运动反应：3分）。昏迷恢复量表修订版评分为10分（听觉功能：2分，视觉功能：3分，运动功能：2分，言语功能：2分，沟通：0分，觉醒：1分）。对ARAS进行的扩散张量纤维束成像（DTT）结果显示，左下腹侧ARAS、双侧下腹侧ARAS以及双侧上ARAS的神经连接性降低。据我们所知，这是首例通过DTT诊断双侧脑桥梗死中ARAS损伤的报告。我们推测，我们的报告将使临床医生更好地理解脑桥梗死患者意识障碍的机制。
