| 제목 |
Change in the precuneus with recovery of impaired consciousness in a patient with HI-BI |
| 소속 |
Yeungnam University Medical Center, Department of Rehabilitation Medicine1 |
| 저자 |
Han Do Lee1,1†, Sung Ho Jang1,1†, Min Son Kim1,1*† |
Objectives: We report on the application of diffusion tensor tractography (DTT) to the ascending reticular activating system (ARAS) of a patient and observing a change in the precuneus with concomitant recovery of impaired consciousness in a patient with hypoxic-ischemic brain injury (HI-BI).
Case presentation: A 50-year-old male patient suffered cardiac arrest induced by an ST-segment elevation myocardial infarction. At eight months after onset, when he started rehabilitation at our hospital, the patient was a vegetative state (VS) with a Coma Recovery Scale-Revised (CRS-R) score of 5. He underwent comprehensive rehabilitation including transcranial direct current stimulation (anode at posterior parietal cortex). After two months of rehabilitation, his consciousness had recovered to a minimally conscious state (MCS) with a CRS-R score of 15. As a result, he was able to perform partial grasp-release of his left hand spontaneously and partial flexion-extension of his left great toe on verbal command. On 8-month DTT, decreased neural connectivity of the upper ARAS between the thalamic intralaminar nucleus and the cerebral cortex was observed in both prefrontal and parietal cortices. In contrast to the 8-month DTT, the 10-month DTT revealed increased neural connectivity of the upper ARAS in the left parietal lobe (especially in the precuneus) and the body of the corpus callosum.
Conclusions: Improvement in connectivity in the precuneus was demonstrated in a HI-BI patient who showed recovery from VS to MCS. It appears that the increased neural connectivity to the precuneus contributed to recovery from VS to MCS in this patient. |
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Fig. 1. (A) Brain magnetic resonance images at eight months after onset show leukomalactic lesions in the fronto-parieto-temporo-occipital lobes in both hemispheres. (B) Results of diffusion tensor tractography (DTT) of the upper ascending reticular activating system between the thalamic intralaminar nucleus and the cerebral cortex. On 8-month DTT, decreased neural connectivity of the upper ARAS is present in both the prefrontal and parietal cortices. Compared with the 8-month DTT results, the 10-month DTT revealed increased neural connectivity of the upper ARAS in the left parietal lobe (especially in the precuneus [arrows]) and the body of the corpus callosum.
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