title: Recovery of Hypersomnia Concurrent With Recovery of an Injured Ascending Reticular Activating System in a Stroke Patient: A Case Report.
abstract: We report on a stroke patient who showed recovery of hypersomnia concurrent with the recovery of an injured ascending reticular activating system (ARAS), which was demonstrated by diffusion tensor tractography (DTT).A 70-year-old female patient underwent coiling of the left ruptured posterior communicating artery after subarachnoid hemorrhage and both extraventricular drainage for management of an intraventricular hemorrhage. At 2 months after onset, when she started rehabilitation, she exhibited intact consciousness, with the full score on the Glasgow Coma Scale: 15. However, she showed severe hypersomnia: she always fell asleep without external stimulation and the Epworth Sleepiness Scale (EPS) score was 24 (full score: 24, cut off for hypersomnia: 10). She underwent comprehensive rehabilitative therapy, including neurotropic drugs, physical therapy, and occupational therapy. Her hypersomnia has shown improvement as 14 (3 months after onset), 11 (4 months after onset), 7 (12 months after onset), and 6 (24 months after onset), respectively.On 2-month DTT, narrowing of both lower dorsal and ventral ARASs was observed on both sides: in particular, among 4 neural tracts of the lower ARAS, the right lower ventral ARAS was the narrowest. By contrast, on 24-month DTT, the 4 narrowed neural tracts of both lower dorsal and ventral ARASs were thickened compared with those of 2-month DTT.Recovery of hypersomnia with recovery of an injured lower ARAS on DTT was observed in a stroke patient. Our results suggest that evaluation of the lower ARAS using DTT might be useful for stroke patients with hypersomnia.
authors.affiliation: From the Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University (HDL, SHJ); Department of Neurosurgery, College of Medicine Yeungnam University (CHC, YJJ).
authors.forename: Sung Ho
authors.initials: SH
authors.lastname: Jang
authors.forename: Han Do
authors.initials: HD
authors.lastname: Lee
authors.forename: Chul Hoon
authors.initials: CH
authors.lastname: Chang
authors.forename: Young Jin
authors.initials: YJ
authors.lastname: Jung
mesh_terms: D000368:Aged; D056324:Diffusion Tensor Imaging; D006970:Disorders of Excessive Somnolence / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D065821:Pontine Tegmentum / Q000293:injuries*; D020127:Recovery of Function; D012154:Reticular Formation / Q000293:injuries* / Q000473:pathology; D018570:Risk Assessment; D020521:Stroke / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed / Q000379:methods