Recovery of multiply injured ascending reticular activating systems in a stroke patient

<正>Consciousness is controlled by activation of the ascending reticular activating system(ARAS).The ARAS consists mainly of the lower and upper parts between the thalamus and cerebral cortex(Edlow et al.,2012;Yeo et al.,2013;Jang et al.,2014).Because the ARAS is composed of several neuronal circuits connecting the brainstem to the cortex.These neuronal connections begin from the reticular formation(RF)of the brainstem and the in-     

Recovery of an injured ascending reticular activating system with recovery from a minimally conscious state to normal consciousness in a stroke patient: a diffusion tensor tractography study

Consciousnessiscontrolledbytheascendingreticularactivating system (ARAS)(Teasdale and Jennett, 1974;Jang and Lee, 2015;Jang et al., 2016a). Scientific medical strategies for recovery in patients with impaired consciousness are relatively few compared with other diseases.     

Multiple injuries of the ascending reticular activating system in a stroke patient:a diffusion tensor tractography study

<正>Consciousness is mainly controlled by activation of the ascending reticular activating system(ARAS).Diffusion tensor tractography(DTT),which is reconstructed from diffusion tensor imaging(DTI)data,allows reconstruction and evaluation of the ARAS in the live human brain(Yeo et al.,2013;Jang et al.,2014;     

Influence of ascending reticular activating system on preoptic neuronal activity

There is evidence to suggest that the reticular activating system may have an influence on the neurons of the preoptic area (POA). We studied the responses of POA neurons and their relation to the cortical EEG, on stimulation of the midbrain reticular formation (MRF) at various frequencies, in unanesthetized, encéphale isolé cats. Stimulation of the MRF at high frequency produced inhibition of the firing rate in a majority of the responsive neurons of the POA. Stimulation of the MRF with lower frequencies, on the other hand, induced excitation in a majority of the responsive POA neurons. The possibility exists of a summation of stimuli and an involvement of structures bringing about changes in the EEG in causing the shift in the POA neuronal excitability.     

Impaired consciousness caused by injury of the lower ascending reticular activating system: evaluation by diffusion tensor tractography

正A 34-year-old male patient underwent conservative management for traumatic hemorrhage in the right frontal lobe(Figure 1A).The patient lost consciousness for approximately 4 weeks and experienced post-traumatic amnesia continuously from the time of the accident.The patient’s Glasgow Coma Scale score(Teasdale et al.,1974)was 6     

Recovery of an injured corticospinal tract by subcortical peri-lesional reorganization in a patient with intracerebral hemorrhage

正The corticospinal tract(CST)is a neural tract responsible for motor function in the human brain.It is mainly related to hand movements(Jang,2014).Therefore,recovery of an injured CST contributes to good recovery in stroke patients and a thorough knowledge of the recovery mechanism regarding an injured     

Optic radiation injury in a patient with intraventricular hemorrhage:a diffusion tensor tractography study

正Optic radiation(OR)injury can occur following various brain injuries and it is usually accompanied by visual field defects(Zhang et al.,2006).OR is very important for performing activities of daily living and providing safety.However,the OR cannot be clearly demarcated from adjacent neural structures and thereby conventional brain MRI has limited specificity in diagnosis of OR injury.Diffusion tensor tractography(DTT),     

Fatal cerebral infarction after intraventricular hemorrhage in a pregnant patient with moyamoya disease.

Moyamoya disease is a progressive occlusive cerebrovascular disorder of unknown etiology. We describe a case of a fatal cerebral infarction after intraventricular hemorrhage in a 29-year-old primipara with moyamoya disease. The patient had been stable for about 10 days after the initial hemorrhage, but she showed a fulminant clinical course of cerebral infarction, and died on the 16th day after the initial hemorrhage. Abnormality in coagulation system and/or cerebral vasospasm may have resulted in such a fulminant clinical course. A possible pathogenesis of this rare condition is discussed.     

Traumatic intraventricular hemorrhage with a good prognosis

We report a 10-year-old girl with an isolated traumatic intraventricular hemorrhage following a traffic accident, who had a good prognosis. Her neurological examination upon arrival was normal and she had no complaint other than headache and vomiting. Computed tomography on admission showed a hemorrhage in the lateral and fourth ventricles. She had a Glasgow Coma Score of 15, and she was thus given only antiepileptic drugs for prophylaxis and followed. Computed tomography that was repeated 5 days after admission showed no blood and all ventricles were of normal size. There was no vascular pathology on magnetic resonance imaging and magnetic resonance angiography. The patient remains well 5 months after her accident. Intraventricular hemorrhage does not always have a poor prognosis.     

Unusual neural connection between injured cingulum and brainstem in a patient with subarachnoid hemorrhage

<正>The human brain is known to have six cholinergic nuclei(Selden et al.,1998;Nieuwenhuys et al.,2008).The cerebral cortex obtains cholinergic innervation mainly from the basalis nucleus of Meynert(Ch 4)in the basal forebrain through the medial and lateral cholinergic pathways(Selden et al.,1998;Mesulam et al.,1983).The cingulum,the neural fiber bundle connecting the basal forebrain and the medial temporal lobe,contains the     

Treatment of sympathomimetic induced intraventricular hemorrhage with intraventricular urokinase

Intraventricular hemorrhage (IVH) occurred in a 32-year-old man following the use of both ephedrine and pseudoephedrine. Cerebral angiography and transcranial Doppler studies showed changes suggestive of vasculitis. We describe the management and investigations of a unique case of IVH. This patient was treated with ventriculostomy and intraventricular urokinase (UK). A favorable outcome was obtained with independent function at 10 weeks post hemorrhage. The use of intraventricular thrombolysis for drug-induced IVH has not previously been reported, although it has been shown to be a safe and potentially beneficial intervention.     

Selective verbal memory impairment due to left fornical crus injury in a patient with intraventricular hemorrhage

<正>The fornix,a part of the Papez circuit,transfers information of episodic memory between the medial temporal lobe and the medial diencephalon(Aggleton and Brown,1999).The right medial temporal lobe is known to be specialized for visual memory and the left medial temporal lobe for verbal memory(Tucker et al.,1988;Aggleton and Brown,1999).Many studies have reported on fornix injury,however,most of them focused on bilateral injury(Tucker et al.,1988;Aggleton et al.,2000;Nakayama et al.,2006;Sugiyama et al.,2007;     

The use of intraventricular thrombolytics in intraventricular hemorrhage

Intraventricular hemorrhage (IVH) is associated with a high mortality and morbidity. Patients with this disorder may now be offered the possibility of treatment. This treatment comes in the form of intraventricular thrombolytics. At present a large randomized trial is testing the efficacy of intraventricular rt-PA in IVH in the setting of intracranial hemorrhage (ICH) . Preliminary data suggests that it may be successful in patients with IVH in this setting. This trial is the accumulation of animal and human trials completed over the last 20 years.     

Increased leukocytes in infants with intraventricular hemorrhage

The objective of this study was to investigate the relationship between intraventricular hemorrhage (IVH) and cystic periventricular leukomalacia (PVL) with changes in the peripheral blood count. Total peripheral leukocytes, absolute neutrophils, platelets, and nucleated erythrocytes from the first 3 days after birth were compared in very-low-birth-weight infants with (n = 100) and without (n = 388) IVH and cystic PVL (n = 16). After controlling for potential confounding variables, infants with IVH had an increase in total leukocytes and absolute neutrophils and a reduction in nucleated erythrocytes compared with infants without IVH. No difference in any parameters studied was evident with regard to cystic PVL. After controlling for potential confounding variables by logistic regression, infants with a peripheral leukocyte count greater than 25,000/mm(3) beyond 24 hours of age had an odds ratio of 2.1 (95% confidence interval = 1.1-4.3) for developing IVH. We conclude that IVH is associated with an increase in total leukocytes and absolute neutrophils for 72 hours after birth in very-low-birth-weight infants. Further investigation is required to determine whether this leukocytosis is important in the pathophysiology of brain injury or is an associated factor.     

Neurodevelopmental outcome in children with intraventricular hemorrhage

To clarify the neurodevelopmental outcome in children with intraventricular hemorrhage, a follow-up study was performed for a consecutive group of 335 subjects in one tertiary center born between 1981 and 1999. Their mean gestation and birth weight were 28.1 weeks and 1162.2 gm, respectively. The follow-up period ranged from 3 to 20 years (mean: 7.5 years). The neurodevelopmental outcomes were normal in 188 (56.1%), cerebral palsy in 75 (22.4%), mental retardation in 34 (10.2%), and borderline intelligence in 38 (11.3%). There were statistically significant differences in the outcomes among the groups with different grades of intraventricular hemorrhage. Approximately 70% of the children with intraventricular hemorrhage grade 1 were normal, whereas only 15.4% of the children with intraventricular hemorrhage grade 4 were normal. Cerebral palsy was associated with as high as 71.2% in the patients with intraventricular hemorrhage grade 4. The overall incidence of epilepsy was 39/335 (11.6%). This study has not demonstrated clear improvement of the outcome in children with intraventricular hemorrhage between the 1980s and 1990s.