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Neuroanatomical correlates of brainstem coma
Josef Parvizi1, Antonio R Damasio
1Department of Neurology, Division of Cognitive Neuroscience, University of Iowa College of Medicine, Iowa City, IA 52242, USA. parvizi.josef@mayo.edu
Brain : a Journal of Neurology
|June 14, 2003
Summary
Brainstem tegmentum lesions, particularly in the upper pons, can cause coma and fatal hyperthermia. Specific nuclei like the rostral raphe complex and locus coeruleus are critical for consciousness.
Area of Science:
- Neuroscience
- Neurology
- Neuroanatomy
Background:
- The brainstem tegmentum, including the reticular formation, plays a role in consciousness.
- Damage to this area is linked to coma, but specific nuclei involved remain unclear.
Purpose of the Study:
- To identify specific brainstem tegmentum nuclei crucial for maintaining consciousness in humans.
- To investigate the relationship between lesion location and coma or hyperthermia.
Main Methods:
- Retrospective study of 47 brainstem stroke patients' MRIs.
- Lesion boundaries charted and mapped onto high-resolution MRI and histological specimens.
- Clinical and post-mortem data used for verification.
Main Results:
- Coma patients (n=9) had bilateral tegmental lesions, often in the upper pons and midbrain.
- Non-coma patients (n=38) had lesions outside the tegmentum or small unilateral ones.
- Maximum lesion overlap in coma patients indicated involvement of rostral raphe complex, locus coeruleus, and other pontine nuclei.
- Fatal hyperthermia cases showed lesion overlap centered in the pontine tegmentum core.
Conclusions:
- Upper pons lesions can cause coma independently of midbrain damage.
- Specific brainstem nuclei are implicated in loss of consciousness and fatal hyperthermia.
- Findings identify key structures for consciousness maintenance within the brainstem tegmentum.