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Increased thalamocortical connectivity to the medial prefrontal cortex with recovery of impaired consciousness in a stroke patient: A case report

RATIONALE: We report a stroke patient who showed increased thalamocortical connectivity to the medial prefrontal cortex (mPFC) with recovery of impaired consciousness that was demonstrated on diffusion tensor tractography (DTT) of the ascending reticular activating system (ARAS). PATIENTS CONCERNS:...

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Autores principales: Jang, Sung Ho, Seo, You Sung, Lee, Sung Jun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440307/
https://www.ncbi.nlm.nih.gov/pubmed/32358365
http://dx.doi.org/10.1097/MD.0000000000019937
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author Jang, Sung Ho
Seo, You Sung
Lee, Sung Jun
author_facet Jang, Sung Ho
Seo, You Sung
Lee, Sung Jun
author_sort Jang, Sung Ho
collection PubMed
description RATIONALE: We report a stroke patient who showed increased thalamocortical connectivity to the medial prefrontal cortex (mPFC) with recovery of impaired consciousness that was demonstrated on diffusion tensor tractography (DTT) of the ascending reticular activating system (ARAS). PATIENTS CONCERNS: A 48-year-old male patient underwent craniectomy and hematoma removal for spontaneous intracerebral hemorrhage in the right basal ganglia and thalamus. When he started rehabilitation at 5 weeks after onset he was in a vegetative state with a Coma Recovery Scale-Revised score of 6. DIAGNOSES: The patient was diagnosed spontaneous intracerebral hemorrhage in the right basal ganglia and thalamus. INTERVENTIONS: He underwent comprehensive rehabilitation including neurotropic durgs, transcranial direct current stimulation, and repetitive transcranial magnetic stimulation of the left prefrontal lobe (Brodmann area 10). OUTCOMES: After 5 weeks of rehabilitation, the patient had recovered to a nearly normal conscious state with a Coma Recovery Scale-Revised score of 22. On 10-week DTT, thickening of the lower dorsal ARAS was observed on both sides compared with 5-week DTT. Decreased neural connectivity to the left PFC was observed on 5-week DTT whereas decreased neural connectivity to the left PFC was increased on 10-week DTT, especially the mPFC. LESSONS: Increased thalamocortical connectivity to the mPFC was demonstrated in a stroke patient who showed concomitant recovery from a vegetative state to a nearly normal conscious state. The results suggest that the increased neural connectivity to the mPMC contributed to recovery of consciousness in this patient.
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spelling pubmed-74403072020-09-04 Increased thalamocortical connectivity to the medial prefrontal cortex with recovery of impaired consciousness in a stroke patient: A case report Jang, Sung Ho Seo, You Sung Lee, Sung Jun Medicine (Baltimore) 5300 RATIONALE: We report a stroke patient who showed increased thalamocortical connectivity to the medial prefrontal cortex (mPFC) with recovery of impaired consciousness that was demonstrated on diffusion tensor tractography (DTT) of the ascending reticular activating system (ARAS). PATIENTS CONCERNS: A 48-year-old male patient underwent craniectomy and hematoma removal for spontaneous intracerebral hemorrhage in the right basal ganglia and thalamus. When he started rehabilitation at 5 weeks after onset he was in a vegetative state with a Coma Recovery Scale-Revised score of 6. DIAGNOSES: The patient was diagnosed spontaneous intracerebral hemorrhage in the right basal ganglia and thalamus. INTERVENTIONS: He underwent comprehensive rehabilitation including neurotropic durgs, transcranial direct current stimulation, and repetitive transcranial magnetic stimulation of the left prefrontal lobe (Brodmann area 10). OUTCOMES: After 5 weeks of rehabilitation, the patient had recovered to a nearly normal conscious state with a Coma Recovery Scale-Revised score of 22. On 10-week DTT, thickening of the lower dorsal ARAS was observed on both sides compared with 5-week DTT. Decreased neural connectivity to the left PFC was observed on 5-week DTT whereas decreased neural connectivity to the left PFC was increased on 10-week DTT, especially the mPFC. LESSONS: Increased thalamocortical connectivity to the mPFC was demonstrated in a stroke patient who showed concomitant recovery from a vegetative state to a nearly normal conscious state. The results suggest that the increased neural connectivity to the mPMC contributed to recovery of consciousness in this patient. Wolters Kluwer Health 2020-05-01 /pmc/articles/PMC7440307/ /pubmed/32358365 http://dx.doi.org/10.1097/MD.0000000000019937 Text en Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
spellingShingle 5300
Jang, Sung Ho
Seo, You Sung
Lee, Sung Jun
Increased thalamocortical connectivity to the medial prefrontal cortex with recovery of impaired consciousness in a stroke patient: A case report
title Increased thalamocortical connectivity to the medial prefrontal cortex with recovery of impaired consciousness in a stroke patient: A case report
title_full Increased thalamocortical connectivity to the medial prefrontal cortex with recovery of impaired consciousness in a stroke patient: A case report
title_fullStr Increased thalamocortical connectivity to the medial prefrontal cortex with recovery of impaired consciousness in a stroke patient: A case report
title_full_unstemmed Increased thalamocortical connectivity to the medial prefrontal cortex with recovery of impaired consciousness in a stroke patient: A case report
title_short Increased thalamocortical connectivity to the medial prefrontal cortex with recovery of impaired consciousness in a stroke patient: A case report
title_sort increased thalamocortical connectivity to the medial prefrontal cortex with recovery of impaired consciousness in a stroke patient: a case report
topic 5300
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440307/
https://www.ncbi.nlm.nih.gov/pubmed/32358365
http://dx.doi.org/10.1097/MD.0000000000019937
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