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Neurology. 2019 Sep 24;93(13):e1281-e1287. doi: 10.1212/WNL.0000000000008163. Epub 2019 Sep 4.

Disruption of the ascending arousal network in acute traumatic disorders of consciousness.

Author information

1
From the Center for Neurotechnology and Neurorecovery (S.B.S., Y.G.B., B.L.E.), Department of Neurology, and Department of Anesthesiology (E.N.B.), Massachusetts General Hospital, Boston; Department of Physical Medicine and Rehabilitation (Y.G.B.), Spaulding Rehabilitation Hospital, Charlestown, MA; Department of Radiology (M.B., O.W., B.L.E.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown; Department of Brain and Cognitive Sciences (E.N.B.), Massachusetts Institute of Technology; and Harvard-MIT Division of Health Science and Technology (E.N.B.), Cambridge, MA.
2
From the Center for Neurotechnology and Neurorecovery (S.B.S., Y.G.B., B.L.E.), Department of Neurology, and Department of Anesthesiology (E.N.B.), Massachusetts General Hospital, Boston; Department of Physical Medicine and Rehabilitation (Y.G.B.), Spaulding Rehabilitation Hospital, Charlestown, MA; Department of Radiology (M.B., O.W., B.L.E.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown; Department of Brain and Cognitive Sciences (E.N.B.), Massachusetts Institute of Technology; and Harvard-MIT Division of Health Science and Technology (E.N.B.), Cambridge, MA. bedlow@mgh.harvard.edu.

Abstract

OBJECTIVE:

To determine whether ascending arousal network (AAn) connectivity is reduced in patients presenting with traumatic coma.

METHODS:

We performed high-angular-resolution diffusion imaging in 16 patients with acute severe traumatic brain injury who were comatose on admission and in 16 matched controls. We used probabilistic tractography to measure the connectivity probability (CP) of AAn axonal pathways linking the brainstem tegmentum to the hypothalamus, thalamus, and basal forebrain. To assess the spatial specificity of CP differences between patients and controls, we also measured CP within 4 subcortical pathways outside the AAn.

RESULTS:

Compared to controls, patients showed a reduction in AAn pathways connecting the brainstem tegmentum to a region of interest encompassing the hypothalamus, thalamus, and basal forebrain. When each pathway was examined individually, brainstem-hypothalamus and brainstem-thalamus CPs, but not brainstem-forebrain CP, were significantly reduced in patients. Only 1 subcortical pathway outside the AAn showed reduced CP in patients.

CONCLUSIONS:

We provide initial evidence for the reduced integrity of axonal pathways linking the brainstem tegmentum to the hypothalamus and thalamus in patients presenting with traumatic coma. Our findings support current conceptual models of coma as being caused by subcortical AAn injury. AAn connectivity mapping provides an opportunity to advance the study of human coma and consciousness.

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