The ascending reticular activating system (ARAS) is known to play an essential role in maintaining arousal and consciousness. In this report, we describe the case of a patient with impaired consciousness due to injury of the ARAS after bilateral pontine infarction. A 73-year-old female patient presented with anterior chest pain to the Emergency Department of our university hospital. She was diagnosed with chronic stable angina pectoris, three-vessel disease, and chronic total occlusion of the left anterior descending artery by coronary angiography and received conservative treatment. After five days, she showed deep drowsy mentality and brain MRI revealed bilateral paramedian pontine infarction. Four weeks after the pontine infarction, she showed severely impaired consciousness, with a Glasgow Coma Scale score of 7 (eye-opening: 2, best verbal response: 2, and best motor response: 3). Coma Recovery Scale-Revised score was 10 (auditory function: 2, visual function: 3, motor function: 2, verbal function: 2, communication: 0, and arousal: 1). Results of diffusion tensor tractography (DTT) for the ARAS showed decreased neural connectivity in the left lower dorsal ARAS, both lower ventral ARAS, and both upper ARAS. To the best of our knowledge, this is the first report of injury to the ARAS in bilateral pontine infarction diagnosed by DTT. We presume that our report would provide clinicians a better understanding of the mechanism of impaired consciousness in patients with pontine infarction.

中文翻译：

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双侧脑桥梗死患者上升网状激活系统损伤引起的意识障碍：一例报告

提升的网状激活系统（ARAS）在维持唤醒和意识方面起着至关重要的作用。在本报告中，我们描述了因双侧脑桥梗死后ARAS损伤而导致意识障碍的患者。一名73岁的女性患者因前胸痛到我校医院急诊科就诊。她被冠状动脉造影诊断为慢性稳定型心绞痛，三支血管疾病和左前降支的慢性完全闭塞，并接受了保守治疗。五天后，她表现出沉睡的头脑，脑部MRI显示双侧正中桥脑梗死。桥脑梗死后四周，她的意识严重受损，格拉斯哥昏迷评分为7分（睁眼：2，最佳言语反应：2，最佳运动反应：3）。昏迷恢复量表修订评分为10（听觉功能：2，视觉功能：3，运动功能：2，言语功能：2，交流：0，觉醒：1）。ARAS的弥散张量束测图（DTT）结果显示左下背侧ARAS，下腹侧ARAS和上侧ARAS的神经连通性均降低。据我们所知，这是DTT诊断的双侧桥脑梗死ARAS损伤的首例报道。我们认为我们的报告将为临床医生更好地了解桥脑梗死患者意识障碍的机制。1）。ARAS的弥散张量束测图（DTT）结果显示，左下背侧ARAS，下腹侧ARAS和上侧ARAS的神经连通性均降低。据我们所知，这是DTT诊断的双侧桥脑梗死ARAS损伤的首例报道。我们认为我们的报告将为临床医生更好地了解桥脑梗死患者意识障碍的机制。1）。ARAS的弥散张量束测图（DTT）结果显示左下背侧ARAS，下腹侧ARAS和上侧ARAS的神经连通性均降低。据我们所知，这是DTT诊断的双侧桥脑梗死ARAS损伤的首例报告。我们认为我们的报告将为临床医生更好地了解桥脑梗死患者意识障碍的机制。