Impaired Consciousness Due to Injury of Ascending Reticular Activating System

A 75-year-old female patient presented with impaired consciousness, and was diagnosed with multiple cerebral infarctions in both hemispheres, including bilateral caudate nuclei and right cingulums (Fig.1-A). Although she was diagnosed with a left pontine infarct eight months prior, she recovered fully without any sequelae. At one month after the multiple infarcts, she was transferred to the department of rehabilitation and revealed severely impaired consciousness, with a Glasgow Coma Scale score of 4 (eye opening: 2, best verbal response: 1, and best motor response: 1) and Coma Recovery Scale-Revised score of 3 (auditory function: 0, visual function: 1, motor function: 1, verbal function: 0, communication: 0, and arousal: 1) [1,2]. She underwent comprehensive rehabilitation for two months, although her consciousness did not recover significantly, with a Glasgow Coma Scale score of 8 (eye opening: 4, best verbal response: 1, and best motor response: 3) and Coma Recovery Scale-Revised score of 8 (auditory function: 1, visual function: 3, motor function: 2, verbal function: 0, communication: 0, and arousal: 2) [1,2]