Evidence map›Paper›PMID 31484715›Full record

ArticleNeurology2019

Disruption of the ascending arousal network in acute traumatic disorders of consciousness.

Samuel B Snider, Yelena G Bodien, Marta Bianciardi, Emery N Brown, Ona Wu, Brian L Edlow

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Neurology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 46 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
46citing papers in PubMed, 1 pooled it
6.2field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

46 citing papers in PubMed, 1 synthesis or guideline pooled it, 79 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Probabilistic mapping and automated segmentation of human brainstem white matter bundles.Proceedings of the National Academy of Sciences of the United States of America · 2026
    Article
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  7. Observational
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  15. Neuroimaging in Disorders of Consciousness and Recovery.Physical medicine and rehabilitation clinics of North America · 2024
    Review
  16. Article
  17. Article
  18. Article
  19. Behavioral scales variability in patients with prolonged disorders of consciousness.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2023
    Article
  20. Prognosis of consciousness disorders in the intensive care unit.Presse medicale (Paris, France : 1983) · 2023
    Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors at 3 institutions in 1 country.

Samuel B SniderFrom the Center for Neurotechnology and Neurorecovery (S.B.S., Y.G.B., B.L.E.), Department of Neurology, and Department of Anesthesiology (E.N.B.), Massachusetts General Hospital, Boston; Department of Physical Medicine and Rehabilitation (Y.G.B.), Spaulding Rehabilitation Hospital, Charlestown, MA; Department of Radiology (M.B., O.W., B.L.E.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown; Department of Brain and Cognitive Sciences (E.N.B.), Massachusetts Institute of Technology; and Harvard-MIT Division of Health Science and Technology (E.N.B.), Cambridge, MA.
Yelena G BodienFrom the Center for Neurotechnology and Neurorecovery (S.B.S., Y.G.B., B.L.E.), Department of Neurology, and Department of Anesthesiology (E.N.B.), Massachusetts General Hospital, Boston; Department of Physical Medicine and Rehabilitation (Y.G.B.), Spaulding Rehabilitation Hospital, Charlestown, MA; Department of Radiology (M.B., O.W., B.L.E.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown; Department of Brain and Cognitive Sciences (E.N.B.), Massachusetts Institute of Technology; and Harvard-MIT Division of Health Science and Technology (E.N.B.), Cambridge, MA.
Marta BianciardiFrom the Center for Neurotechnology and Neurorecovery (S.B.S., Y.G.B., B.L.E.), Department of Neurology, and Department of Anesthesiology (E.N.B.), Massachusetts General Hospital, Boston; Department of Physical Medicine and Rehabilitation (Y.G.B.), Spaulding Rehabilitation Hospital, Charlestown, MA; Department of Radiology (M.B., O.W., B.L.E.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown; Department of Brain and Cognitive Sciences (E.N.B.), Massachusetts Institute of Technology; and Harvard-MIT Division of Health Science and Technology (E.N.B.), Cambridge, MA.
Emery N BrownFrom the Center for Neurotechnology and Neurorecovery (S.B.S., Y.G.B., B.L.E.), Department of Neurology, and Department of Anesthesiology (E.N.B.), Massachusetts General Hospital, Boston; Department of Physical Medicine and Rehabilitation (Y.G.B.), Spaulding Rehabilitation Hospital, Charlestown, MA; Department of Radiology (M.B., O.W., B.L.E.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown; Department of Brain and Cognitive Sciences (E.N.B.), Massachusetts Institute of Technology; and Harvard-MIT Division of Health Science and Technology (E.N.B.), Cambridge, MA.
Ona WuFrom the Center for Neurotechnology and Neurorecovery (S.B.S., Y.G.B., B.L.E.), Department of Neurology, and Department of Anesthesiology (E.N.B.), Massachusetts General Hospital, Boston; Department of Physical Medicine and Rehabilitation (Y.G.B.), Spaulding Rehabilitation Hospital, Charlestown, MA; Department of Radiology (M.B., O.W., B.L.E.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown; Department of Brain and Cognitive Sciences (E.N.B.), Massachusetts Institute of Technology; and Harvard-MIT Division of Health Science and Technology (E.N.B.), Cambridge, MA.
Brian L EdlowFrom the Center for Neurotechnology and Neurorecovery (S.B.S., Y.G.B., B.L.E.), Department of Neurology, and Department of Anesthesiology (E.N.B.), Massachusetts General Hospital, Boston; Department of Physical Medicine and Rehabilitation (Y.G.B.), Spaulding Rehabilitation Hospital, Charlestown, MA; Department of Radiology (M.B., O.W., B.L.E.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown; Department of Brain and Cognitive Sciences (E.N.B.), Massachusetts Institute of Technology; and Harvard-MIT Division of Health Science and Technology (E.N.B.), Cambridge, MA. bedlow@mgh.harvard.edu.
Center for Neuro-Oncology · USSpaulding Rehabilitation Hospital · USMassachusetts Institute of Technology · US

Funding

Project 4: Mathematical Modeling Studies of Anesthetic ActionP01GM118269 · NIGMS · MASSACHUSETTS GENERAL HOSPITAL · PI BROWN, EMERY N · 2017 to 2021
$9.0M
Redesigning General Anesthesia (Admin Supp)R01GM104948 · NIGMS · MASSACHUSETTS INSTITUTE OF TECHNOLOGY · PI BOYDEN, EDWARD S., BROWN, EMERY N · 2012 to 2016
$4.4M
Brainstem Network Determinants of Recovery from Traumatic ComaK23NS094538 · NINDS · MASSACHUSETTS GENERAL HOSPITAL · PI EDLOW, BRIAN L. · 2015 to 2019
$994k
In vivo atlas of the ascending arousal system in health and traumatic comaK01EB019474 · NIBIB · MASSACHUSETTS GENERAL HOSPITAL · PI BIANCIARDI, MARTA · 2016 to 2019
$691k
NCCDPHP CDC HHS U48 DP000039NIBIB NIH HHS K01 EB019474NIGMS NIH HHS P01 GM118269NIGMS NIH HHS R01 GM104948NINDS NIH HHS K23 NS094538
6 · The paper itself

Abstract

objectiveTo determine whether ascending arousal network (AAn) connectivity is reduced in patients presenting with traumatic coma.

methodsWe performed high-angular-resolution diffusion imaging in 16 patients with acute severe traumatic brain injury who were comatose on admission and in 16 matched controls. We used probabilistic tractography to measure the connectivity probability (CP) of AAn axonal pathways linking the brainstem tegmentum to the hypothalamus, thalamus, and basal forebrain. To assess the spatial specificity of CP differences between patients and controls, we also measured CP within 4 subcortical pathways outside the AAn.

resultsCompared to controls, patients showed a reduction in AAn pathways connecting the brainstem tegmentum to a region of interest encompassing the hypothalamus, thalamus, and basal forebrain. When each pathway was examined individually, brainstem-hypothalamus and brainstem-thalamus CPs, but not brainstem-forebrain CP, were significantly reduced in patients. Only 1 subcortical pathway outside the AAn showed reduced CP in patients.

conclusionsWe provide initial evidence for the reduced integrity of axonal pathways linking the brainstem tegmentum to the hypothalamus and thalamus in patients presenting with traumatic coma. Our findings support current conceptual models of coma as being caused by subcortical AAn injury. AAn connectivity mapping provides an opportunity to advance the study of human coma and consciousness.

Indexed as

AdultArousalBasal ForebrainBrain InjuriesBrain Injuries, TraumaticBrain StemConsciousnessFemaleHumansMaleNeural PathwaysThalamus

Identifiers

PMID31484715
PMCPMC7011864
OpenAlexW2972034337

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.