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. 2020 Oct 14;20(1):375.
doi: 10.1186/s12883-020-01942-7.

The relationship between consciousness and the ascending reticular activating system in patients with traumatic brain injury

Sung Ho Jang  1 , Young Hyeon Kwon  2
Affiliations

The relationship between consciousness and the ascending reticular activating system in patients with traumatic brain injury

Sung Ho Jang et al. BMC Neurol. .

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: Ascending reticular activating system; Consciousness; Diffusion tensor tractography; Glasgow coma scale; Traumatic brain injury.

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Conflict of interest statement

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individual in control of the content of this article.

Figures

Fig. 1
Fig. 1
Results of diffusion tensor tractography (DTT) for the ascending reticular activating system (ARAS). a T2-weighted brain magnetic resonance images at the time of diffusion tensor imaging scanning in representative subjects of patient subgroup A (71-year-old female), patient subgroup B (33-year-old male), and the control group (50-year-old female). b Results of DTT for the lower dorsal ARAS. Narrowing (yellow arrows) is observed in both lower dorsal ARAS in patient subgroup A compared to that in patient subgroup B and the control group. c Results of DTT for the upper ARAS. A decreased neural tract (green arrows) is observed in both upper ARAS in patient subgroup A compared with that in patient subgroup B and the control group
See this image and copyright information in PMC

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