Disconnection of the Ascending Arousal System in Traumatic Coma

• DOI: 10.1097/nen.0b013e3182945bf6
• Publication Date: 2013-05-08T11:44:25Z
• Authors: Brian L. Edlow; Robin L. Haynes; Emi Takahashi; Joshua P. Klein; Peter Cummings; Thomas Benner; David M. Greer; Steven M. Greenberg; Ona Wu; Hannah C. Kinney; Rebecca D. Folkerth
• Keywords: Forebrain; Disconnection; Reticular activating system

Traumatic coma is associated with disruption of axonal pathways throughout the brain, but specific involved in humans are incompletely understood. In this study, we used high angular resolution diffusion imaging to map connectivity that mediate 2 critical components consciousness-arousal and awareness-in postmortem brain a 62-year-old woman acute traumatic control brains. High tractography guided tissue sampling neuropathologic analysis. demonstrated complete white matter connecting brainstem arousal nuclei basal forebrain thalamic intralaminar reticular nuclei. contrast, hemispheric thalamus cerebral cortex were only partially disrupted, as cortical "awareness pathways." Neuropathologic examination, which β-amyloid precursor protein fractin immunomarkers, revealed injury hemispheres corresponded sites tract disruption. Axonal was also present within gray hypothalamus, thalamus, forebrain, cortex. We propose may be subcortical disconnection syndrome related from forebrain.