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Relationship between consciousness and injury of ascending reticular activating system in patients with hypoxic ischaemic brain injury
  1. Sung Ho Jang1,
  2. Jong Sun Park2,
  3. Dong Gu Shin2,
  4. Seong Ho Kim3,
  5. Min Son Kim1
  1. 1 Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
  2. 2 Department of Internal Medicine-Cardiology, College of Medicine, Yeungnam University, Daegu, Republic of Korea
  3. 3 Department of Neurosurgery, College of Medicine, Yeungnam University, Namku, Daegu, Republic of Korea
  1. Correspondence to Dr Min Son Kim, Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea; draco91{at}

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Impaired consciousness is one of the main sequelae of hypoxic ischemic brain injury(HI-BI).1 The ascending reticular activating system (ARAS) comprised arousal pathways and awareness networks, which mainly originates in the reticular formation of the brainstem and projects to the cerebral cortex through synaptic relays in the intralaminar thalamic nucleus, hypothalamus, basal forebrain and several brainstem nuclei.2 Depending on the severity of HI-BI and the timing of imaging, conventional brain MRI usually shows high-signal intensity in the vulnerable areas (eg, basal ganglia, thalamus, hippocampus, cerebellum and cortex). However, it has limitations when demonstrating ARAS injuries. Diffusion tensor tractography (DTT) derived from diffusion tensor imaging (DTI), an imaging technique for evaluation of the integrity of white matter through assessment of water diffusion characteristics, has enabled three-dimensional reconstruction of the three parts of the ARAS: thalamocortical connections, lower dorsal ARAS and lower ventral ARAS. Several studies using DTT have demonstrated injury of the ARAS in patients with HI-BI. However, the relationship between consciousness and the ARAS is unclear.

In this study, we investigated the relationship between injury of the ARAS and consciousness in patients with HI-BI by using DTT.



Twenty-nine patients with HI-BI (from January 2013 to September 2017) and 21 age-matched and sex-matched healthy control subjects were recruited. The Glasgow Coma Scale (GCS) and Coma Recovery Scale-Revised (CRS-R) were used to evaluate the consciousness of the patients at the …

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  • Contributors SHJ conceived and designed the study and was involved in funding and data acquisition, manuscript development, and manuscript writing. JSP, DGS and SHK participated in the design of the study and collection of data. MSK participated in manuscript development, data acquisition, manuscript writing and manuscript authorisation. All authors reviewed the manuscript.

  • Funding This work was supported by the National Research Foundation (NRF) of Korea Grant funded by the Korean Government (MSIP) (2018R1A2B6000996).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The study protocol was approved by the Institutional Review Board of Yeungnam University Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.