title: Change of ascending reticular activating system with recovery from vegetative state to minimally conscious state in a stroke patient.
abstract: BACKGROUND
  We report on a stroke patient who showed change of the ascending reticular activating system (ARAS) concurrent with recovery from a vegetative state (VS) to a minimally conscious state (MCS), which was demonstrated on diffusion tensor tractography (DTT).
  
  
  METHODS
  A 59-year-old male patient underwent CT-guided stereotactic drainage 3 times for management of intracerebral hemorrhage and intraventricular hemorrhage.
  
  
  METHODS
  After 4 months from onset, when starting rehabilitation, the patient showed impaired consciousness, with a Glasgow Coma Scale (GCS) score of 6 and a Coma Recovery Scale-Revised score of 2. At 10 months after onset, his GCS score had recovered to 11 with a GRS-R score of 20, and he was able to perform rock-scissors-paper using his right hand according to verbal command.
  
  
  METHODS
  On 10-month DTT, marked increased neural connectivity of the thalamic intralaminar nucleus (ILN) to the cerebral cortex was observed in both prefrontal cortexes and the right thalamus compared with 4-month DTT. However, no significant change was observed in the lower dorsal ARAS between the pontine reticular formation (PRF) and the thalamic ILN. In addition, the reconstructed lower ventral ARAS between the PRF and hypothalamus had disappeared in both hemispheres on 10-month DTT.
  
  
  RESULTS
  Change of the ARAS was demonstrated in a stroke patient who showed recovery from a VS to an MCS.
  
  
  CONCLUSIONS
  It appeared that the prefrontal cortex and thalamus, which showed increased neural connectivity, contributed to recovery from a VS to an MCS in this patient.
authors.affiliation: Department of Physical Medicine and Rehabilitation Department of Neurosurgery, College of Medicine, Yeungnam University, Taegu, Republic of Korea.
authors.forename: Sung Ho
authors.initials: SH
authors.lastname: Jang
authors.forename: Chul Hoon
authors.initials: CH
authors.lastname: Chang
authors.forename: Young Jin
authors.initials: YJ
authors.lastname: Jung
authors.forename: You Sung
authors.initials: YS
authors.lastname: Seo
mesh_terms: D003243:Consciousness; D056324:Diffusion Tensor Imaging; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D018458:Persistent Vegetative State / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D065821:Pontine Tegmentum / Q000502:physiology*; D020127:Recovery of Function; D018570:Risk Assessment; D020521:Stroke / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D013997:Time Factors; D016896:Treatment Outcome