Abstract
Arousal, or wakefulness, is an integral component of consciousness and prerequisite for other brain functions, yet its neuroanatomy in humans is poorly understood. Classically, the brainstem “reticular formation” has been considered important for wakefulness.1 Experiments in rodents suggest this brainstem area can be subdivided into functionally discrete regions, and that injury to one region in the pontine tegmentum reliably disrupts arousal and produces coma.2 A homologous brainstem region is likely present in humans, based on analysis of coma-causing lesions.3 However, it remains unclear whether there is a human brainstem site significantly more associated with coma-causing lesions than with non–coma-causing lesions, and exactly where this site is located. Such a brainstem site would likely maintain arousal through ascending projections to other brain regions (originally termed the ascending reticular activating system, or ARAS),1,4 but this network of brain regions in humans is also unclear.
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