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Thalamic strokes that severely impair arousal extend into the brainstem
Author(s) -
Hindman Joseph,
Bowren Mark D.,
Bruss Joel,
Wright Brad,
Geerling Joel C.,
Boes Aaron D.
Publication year - 2018
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.25377
Subject(s) - tegmentum , stupor , thalamus , arousal , brainstem , midbrain , psychology , neuroscience , lesion , pons , medicine , anesthesia , central nervous system , psychiatry , vomiting
In this study, we evaluate the role of the thalamus in the neural circuitry of arousal. Level of consciousness within the first 12 hours of a thalamic stroke is assessed with lesion symptom mapping. Impaired arousal correlates with lesions in the paramedian posterior thalamus near the centromedian and parafascicular nuclei, posterior hypothalamus, and midbrain tegmentum. All patients with severely impaired arousal (coma, stupor) had lesion extension into the midbrain and/or pontine tegmentum, whereas purely thalamic lesions did not severely impair arousal. These results are consistent with growing evidence that pathways most critical for human arousal lie outside the thalamus. Ann Neurol 2018;84:926–930