Recovery From Vegetative State to Minimally Conscious State: A Case Report

In this study, we attempted to demonstrate the change of the ascending reticular activating system (ARAS) concurrent with the recovery from a vegetative state (VS) to a minimally conscious state (MCS) in a patient with brain injury. A 54-year-old male patient had suffered from head trauma and underwent cardiopulmonary resuscitation immediately after head trauma. At 10 months after onset, the patient exhibited impaired consciousness, with a Coma Recovery Scale-Revised (CRS-R) score of 7 (auditory function: 1, visual function: 2, motor function: 1, verbal function: 1, communication: 0, and arousal: 2) and underwent the ventriculoperitoneal shunt operation for hydrocephalus. After the operation, he began comprehensive rehabilitative therapy. At post-op 2 and 8 weeks, his CRS-R score had recovered to 15 (3/3/4/1/1/3) and 17 (3/3/4/2/2/3), respectively. In terms of configuration on diffusion tensor tractography (DTT), there was no significant change in the lower portion of the ARAS. Regarding the change of neural connectivity of the thalamic intralaminar nucleus, increased neural connectivities to the hypothalamus, basal forebrain, prefrontal cortex, anterior cingulate cortex, and parietal cortex were observed in both hemispheres on post-op DTTs compared with pre-op DTT. We report on a patient with brain injury who showed change of the ARAS concurrent with the recovery from a VS and a MCS.