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The ascending reticular activating system (ARAS) mediates arousal, an essential component of human consciousness. Lesions of the ARAS cause coma, the most severe disorder of consciousness. Because of current methodological limitations, including of postmortem tissue analysis, the neuroanatomic connectivity of the human ARAS is poorly understood. We applied(More)
Ischemia has been proposed as a cause of transient global amnesia (TGA), but proof has been lacking. The authors performed magnetic resonance imaging on a 77-year-old woman with classic TGA at 4 hours and at 6 days after the onset of symptoms. Her initial diffusion-weighted imaging (DWI) and apparent diffusion coefficient imaging suggested an acute infarct(More)
Since the establishment of the concept of declaring death by brain criteria, a large extent of variability in the determination of brain death has been reported. There are no standardized practical guidelines, and major differences exist in the requirements for the declaration of brain death throughout the USA and internationally. The American Academy of(More)
Cardiac arrest survivors commonly suffer ischemic brain injury, and understanding the mechanisms of injury is essential to providing insight for effective therapies for brain protection. Injury can occur at the time of the cardiac arrest and is dependent not only on the duration but also the degree of impaired circulation. Injury can be ongoing even after(More)
BACKGROUND Therapeutic hypothermia is now commonly used to improve neurologic outcomes in eligible patients after cardiac arrest. The physiologic effects of cooling and pharmacologic effects of sedatives and neuromuscular blocking agents can affect the clinical exam and neurophysiologic findings. This can lead to uncertainty in neurologic prognostication.(More)
Traumatic coma is associated with disruption of axonal pathways throughout the brain, but the specific pathways involved in humans are incompletely understood. In this study, we used high angular resolution diffusion imaging to map the connectivity of axonal pathways that mediate the 2 critical components of consciousness-arousal and awareness-in the(More)
INTRODUCTION Fever is common and difficult to control in patients with subarachnoid hemorrhage (SAH). We have previously shown an inverse relationship between fever and outcome in patients with SAH. MATERIALS/METHODS This was a prospective, single-arm, feasibility trial in which nine patients with SAH underwent temperature management using an(More)
INTRODUCTION Ancillary testing is frequently required in the determination of death by brain criteria, particularly in cases in which the clinical examination is drawn into question. Newer tests, such as computed tomographic angiography (CTA), have garnered enthusiasm for their ease of performance, but have not been validated as acceptable tests compared(More)
BACKGROUND AND PURPOSE Many studies associate fever with poor outcome in patients with neurological injury, but this relationship is blurred by divergence in populations and outcome measures. We sought to incorporate all recent scholarship addressing fever in brain-injured patients into a comprehensive meta-analysis to evaluate disparate clinical findings.(More)