Recovery of consciousness and an injured ascending reticular activating system in a patient who survived cardiac arrest: A case report
Recovery of consciousness and an injured ascending reticular activating system in a patient who survived cardiac arrest: A case report
复制标题
DOI：
10.1097/md.0000000000004041
复制
发表时间：
2016-06-01
期刊：
影响因子：
1.6
通讯作者：
Lee, Han Do
中科院分区：
文献类型：
--
作者：
Jang, Sung Ho;Hyun, Yi Ji;Lee, Han Do
我们报告了一名患者在心脏骤停后幸存下来，并在缺氧缺血性脑损伤 (HI-BI) 的早期阶段表现出意识恢复和 ARAS 损伤，持续了 3 周，这通过扩散张量纤维束成像 (DTT) 得到证实。一名因急性冠状动脉综合征导致心脏骤停的 52 岁男性患者立即被一名外行和护理人员复苏，时间约为 25 分钟。随后他立即被转移到当地医疗中心的急诊室。发病2周开始康复时，意识受损，格拉斯哥昏迷量表（GCS）评分为8分，昏迷恢复量表修订版（GRS-R）评分为8分，接受了综合康复治疗，包括意识恢复药物。他恢复良好且迅速，发病5周后，他的意识在GCS：15和GRS-R：23方面已恢复至满分。与2周DTT相比，5周DTT时左下背侧和右下腹侧ARAS变得更厚（图1B）。关于丘脑 ILN 神经连接的变化，与 2 周 DTT 相比，5 周 DTT 时观察到两个半球与基底前脑和前额叶皮质的神经连接增加。在一名心脏骤停幸存的患者中证明了受伤的 ARAS 的恢复，并且他的意识在 HI-BI 早期 3 周内表现出快速良好的恢复。
We report on a patient who survived cardiac arrest and showed recovery of consciousness and an injured ARAS at the early stage of hypoxic-ischemic brain injury (HI- BI) for 3 weeks, which was demonstrated by diffusion tensor tractography (DTT).A 52-year-old male patient who had suffered cardiac arrest caused by acute coronary syndrome was resuscitated immediately by a layman and paramedics for approximate to 25 minutes. He was then transferred immediately to the emergency room of a local medical center. When starting rehabilitation at 2 weeks after onset, his consciousness was impaired, with a Glasgow Coma Scale (GCS) score of 8 and Coma Recovery Scale-Revised (GRS-R) score of 8. He underwent comprehensive rehabilitative therapy, including drugs for recovery of consciousness. He recovered well and rapidly so that his consciousness had recovered to full scores in terms of GCS:15 and GRS-R:23 at 5 weeks after onset.The left lower dorsal and right lower ventral ARAS had become thicker on 5-week DTT compared with 2-week DTT (Fig. 1B). Regarding the change of neural connectivity of the thalamic ILN, increased neural connectivity to the basal forebrain and prefrontal cortex was observed in both hemispheres on 5-week DTT compared with 2-week DTT.Recovery of an injured ARAS was demonstrated in a patient who survived cardiac arrest and his consciousness showed rapid and good recovery for 3 weeks at the early stage of HI-BI.