Abstract

BackgroundWe 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).MethodsTwenty-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.ResultsThe 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).ConclusionsWe 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 registrationYUMC 2019–06–032-003. Retrospectively registered 06 Jun 2020.

Highlights

  • 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)

  • We classified the patient group (26 patients) into two subgroups based on their Glasgow Coma Scale (GCS) score at the time of diffusion tensor imaging (DTI) scanning: 14 patients were placed in subgroup A, and 12 patients were assigned to subgroup B

  • One-way analysis of variance (ANOVA) showed that no significant differences were observed in the mean tract volume (TV) values of the lower dorsal and upper ARAS among patient subgroups A, B and the control group (p > 0.05)

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Summary

Introduction

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). Before the development of diffusion tensor imaging (DTI), precise evaluation of the ARAS in the human brain was limited because the majority of the ARAS is not clearly discriminated from adjacent neural structures. Diffusion tensor tractography (DTT), which is derived from DTI data, enables threedimensional reconstruction, visualization, and evaluation of the ARAS in the live human brain [12,13,14]. A few studies have demonstrated the usefulness of DTT for three-dimensional evaluation of the ARAS in patients with impaired consciousness following TBI [12, 15, 16]. Very little has been reported about the relationship between consciousness and the ARAS in TBI

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