The DOI matches its Crossref record; 18 of the 18 references it cites were found in a registry or an index; none of the 9 sources its claims cite is checked for support yet.
Disruption of the ascending arousal network in acute traumatic disorders of consciousness
Open accessAbstract
OBJECTIVE: To determine whether ascending arousal network (AAn) connectivity is reduced in patients presenting with traumatic coma. METHODS: We 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. RESULTS: Compared 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. CONCLUSIONS: We 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.
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
In 16 patients with acute severe traumatic brain injury who were comatose on admission, high-angular-resolution diffusion imaging (HARDI) probabilistic tractography showed reduced connectivity in ascending arousal network (AAn) pathways compared with 16 matched controls. The reductions were specific to brainstem-hypothalamus and brainstem-thalamus pathways, supporting subcortical AAn injury as a mechanism of traumatic coma.
Key findings
- Normalized tract number between the brainstem tegmentum and a combined target (hypothalamus, thalamus, basal forebrain) was lower in patients (median 0.08, IQR 0.04–0.1) than controls (median 0.1, IQR 0.09–0.12, p = 0.006).
- Seed-to-target connectivity probability (CP) was significantly reduced for brainstem-hypothalamus (patients 0.04, IQR 0.02–0.07 vs controls 0.08, IQR 0.07–0.09, FWE pc < 0.05) and brainstem-thalamus (patients 0.03, IQR 0.01–0.04 vs controls 0.04, IQR 0.04–0.06, pc < 0.05), but not brainstem-forebrain (patients 0.003, IQR 0.002–0.009 vs controls 0.008, IQR 0.004–0.01, pc = 0.37).
- Of 4 non-AAn pathways, only auditory tracts (inferior colliculus to medial geniculate body) showed reduced CP in patients (0.0007, IQR 0.0002–0.001 vs 0.005, IQR 0.002–0.009, pc < 0.005); motor, extrapyramidal, and cerebellar tracts did not differ (all pc > 0.5).
- AAn CPs were not correlated with days in coma or days until command following (all p ≥ 0.29), nor reduced in prolonged (>2 days) versus brief (≤2 days) coma (all p ≥ 0.27). Peak tract reduction was seen in the left lateral midbrain tegmentum and rostral medial tracts to the hypothalamus.
Methods
- Prospective observational study: 16 consecutive patients (median age 27.5 years, IQR 21.5–33, 12 men) with acute traumatic coma (GCS score of 6 without eye opening, no eye opening for 24 hours) and 16 age- and sex-matched controls (median age 27 years, IQR 21–32.5, 12 men).
- HARDI on a 3T Siemens Skyra scanner in the ICU (2-mm isotropic voxels, 60 diffusion-encoded volumes at b = 2,000 s/m², 10 b0 volumes); preprocessing in FSL, diffusion parameters via bedpostx, and probabilistic tractography with probtrackx2 (5,000 samples per voxel).
- Connectivity probability computed between a dorsal brainstem tegmentum seed (Harvard Ascending Arousal Network Atlas) and hypothalamus, thalamus, and basal forebrain targets, plus 4 non-AAn control pathways; group comparisons used Wilcoxon rank-sum tests with Holm FWE adjustment (Benjamini-Hochberg FDR for voxel-wise analysis).
Limitations
- Stated: HARDI tractography depends on intervoxel coherence in directional water diffusion, so focal edema may produce apparent tract disruption even with structurally intact axons, and it cannot distinguish reversibly from irreversibly injured axons.
- Stated: diffusion measures are dynamic during the acute stage of traumatic axonal injury, and because the injury-to-imaging interval varied between patients, correlations between AAn connectivity and clinical measures should be interpreted with caution.
- Stated: the small sample size may have provided inadequate statistical power to detect a correlation between AAn CP reduction and coma duration; the authors also note that comparing comatose TBI patients to TBI patients with preserved consciousness, rather than to healthy controls, would allow more precise anatomic localization.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
10 Own result · 4 Own method · 4 Own interpretation · 3 No full text of the sources · 1 Check pending · 1 Not checked yet
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“but not brainstem-forebrain (patients: 0.003 IQR 0.002–0.009; controls: 0.008, IQR 0.004–0.01, pc = 0.37; figure 1B).”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These results were unaffected by the exclusion of patient 16 (tables e-2 and e-3 available from Dryad, doi.org/10.5061/dryad.43m733k), the only patient who presented with an extra-axial lesion producing significant brainstem compression.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“and brainstem-thalamus (patients: 0.03, IQR 0.01–0.04; controls: 0.04, IQR 0.04–0.06, pc < 0.05)”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Individual seed-to-target analyses revealed significantly reduced CP for brainstem-hypothalamus (patients: 0.04, IQR 0.02–0.07; controls: 0.08, IQR 0.07–0.09, FWE pc< 0.05”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“nor were they reduced in patients with prolonged (>2 days) relative to brief (≤2 days) coma (all p ≥ 0.27).”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We did, however, find a significant group-level CP reduction in auditory tracts (inferior colliculus to medial geniculate body) between patients (0.0007, IQR 0.0002–0.001) and controls (0.005, IQR 0.002–0.009, pc < 0.005; figure 1B).”
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Unlike conventional MRI and diffusion tensor imaging, high-angular-resolution diffusion imaging (HARDI) meets these methodologic requirements by measuring water diffusion along axonal pathways using a multidirectional model designed to detect crossing and branching axons.12”
What the sources say
- Not checked — no full text of the sourcecites [12] Tuch DS, Reese TG, Wiegell MR, Makris N, Belliveau JW, Wedeen VJ. High angular resolution diffusion imaging reveals intravoxel white matter fiber heterogeneity. Magn Reson Med 2002;48:577–582. [DOI] [PubMed] [Google Scholar] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“In traumatic coma, however, up to 44% of patients may not have visible brainstem pathology on conventional MRI sequences.6”
What the sources say
- Not checked — no full text of the sourcecites [6] Weiss N, Galanaud D, Carpentier A, et al. A combined clinical and MRI approach for outcome assessment of traumatic head injured comatose patients. J Neurol 2008;255:217–223. [DOI] [PubMed] [Google Scholar] source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although severe TBI is known to cause heterogeneous subcortical axonal injury, our findings suggest a spatial specificity for AAn pathways among patients who present with coma.”
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Another limitation of this small study is its statistical power, which may have been inadequate to identify a correlation between AAn CP reduction and coma duration.”
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- It may state two separate claims as one. 6
- The quote only partly states this claim. 2
- Probably not a substantial claim. 4
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Brainstem-hypothalamus, brainstem-thalamus, and brainstem-forebrain CPs were not correlated with days in coma or days until command following (all p ≥ 0.29 for Pearson correlation coefficients)”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Compared to healthy controls, patients showed reduced normalized tract number between the brainstem tegmentum and a target encompassing the hypothalamus, thalamus, and basal forebrain (patients: median 0.08, IQR 0.04–0.1; controls: median 0.1, IQR 0.09–0.12, p = 0.006; figure 1A).”
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Peak areas of tract reduction were seen within the left lateral midbrain tegmentum and in the rostral medial tracts connecting the tegmentum to the hypothalamus”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Among non-AAn pathways, we found no group-level CP differences between patients and controls in motor (ventral pons to posterior limb internal capsule) (patients: 0.12, IQR 0.07–0.16; controls: 0.12, IQR 0.11–0.15), extrapyramidal (substantia nigra to basal ganglia) (patients: 0.02, IQR 0.02–0.02; controls: 0.02, IQR 0.02–0.02), or cerebellar (superior cerebellar peduncle to red nucleus) (patients”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one. The quote only partly states this claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“This study was approved by the Massachusetts General Hospital Institutional Review Board. Written informed consent was obtained from each participant or a surrogate.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“In patients with acute severe traumatic brain injury (TBI), coma is believed to be caused by axonal injury within the ascending arousal network (AAn), a collection of subcortical pathways that connect the rostral brainstem tegmentum to the hypothalamus, thalamus, and basal forebrain.1,2”
What the sources say
- Not matchedcites [1] Edlow BL, Takahashi E, Wu O, et al. Neuroanatomic connectivity of the human ascending arousal system critical to consciousness and its disorders. J Neuropathol Exp Neurol 2012;71:531–546. [DOI] [PMC free article] [PubMed] [Google Scholar]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not checked — no full text of the sourcecites [2] Gennarelli TA, Thibault LE, Adams JH, Graham DI, Thompson CJ, Marcincin RP. Diffuse axonal injury and traumatic coma in the primate. Ann Neurol 1982;12:564–574. [DOI] [PubMed] [Google Scholar] source
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Not matched
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Group-level voxel-wise and tract-specific analyses were performed in MATLAB (MathWorks, Natick, MA) with Wilcoxon rank-sum tests. When appropriate, we adjusted p values for multiple comparisons using Holm family-wise error (FWE) adjustment, except for the voxel-wise analysis, in which we used the less-restrictive Benjamini-Hochberg false discovery rate adjustment.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“While these structural connectivity findings do not prove a causal relationship, they support the role of AAn disruption in the pathogenesis of acute traumatic disorders of consciousness.”
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Sixteen age- and sex-matched controls (median age 27 years, IQR 21–32.5 years, 12 men) underwent identical imaging.”
plainn = 16- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
The paper relies on this without support.
Reduced connectivity probability measured by HARDI probabilistic tractography in these patients reflects reduced structural integrity of the underlying axons rather than apparent tract disruption from edema or other non-structural causes.
“HARDI reconstruction of axonal pathways depends on intervoxel coherence in directional water diffusion, and focal intracellular or extracellular edema may lead to an apparent tract disruption even when the underlying axons are structurally intact.”
Citations
Cites
High angular resolution diffusion imaging reveals intravoxel white matter fiber heterogeneity
Tuch, D. S., Reese, T. G., Wiegell, M. R., Makris, N., Belliveau, J. W., & Wedeen, V. J. (2002) · Magnetic Resonance in Medicine · doi:10.1002/mrm.10268 · Cited by 1,548 · cited 1×
“Unlike conventional MRI and diffusion tensor imaging, high-angular-resolution diffusion imaging (HARDI) meets these methodologic requirements by measuring water diffusion along axonal pathways using a multidirectional model designed to detect crossing and branching axons.(12) HARDI thus provides an opportunity to mode…”
BackgroundDiffuse axonal injury and traumatic coma in the primate
Gennarelli, T. A., Thibault, L. E., Adams, J. H., Graham, D. I., Thompson, C. J., & Marcincin, R. P. (1982) · Annals of Neurology · doi:10.1002/ana.410120611 · Cited by 1,528
Reticular formation of the brain
(1959) · Electroencephalography and Clinical Neurophysiology · doi:10.1016/0013-4694(59)90072-0 · Cited by 1,124
Some ascending pathways in the brain stem reticular formation.
Nauta, W. J. H., & Kuypers, H. G. J. M. (1958) · Cited by 570
A Mechanistic Analysis of Nondisruptive Axonal Injury: A Review
Maxwell, W. L., Povlishock, J. T., & Graham, D. I. (1997) · Journal of Neurotrauma · doi:10.1089/neu.1997.14.419 · Cited by 564
Voytko, M., Olton, D., Richardson, R., Gorman, L. K., Tobin, J., & Price, D. L. (1994) · Journal of Neuroscience · doi:10.1523/jneurosci.14-01-00167.1994 · Cited by 520
Edlow, B. L., Takahashi, E., Wu, O., Benner, T., Dai, G., Bu, L., Grant, P. E., Greer, D. M., Greenberg, S. M., Kinney, H. C., et al. (2012) · Journal of Neuropathology & Experimental Neurology · doi:10.1097/nen.0b013e3182588293 · Cited by 497
Self-citationReassessment of the structural basis of the ascending arousal system
Fuller, P., Sherman, D., Pedersen, N. P., Saper, C. B., & Lu, J. (2011) · Journal of Comparative Neurology · doi:10.1002/cne.22559 · Cited by 465
Comprehensive cellular‐resolution atlas of the adult human brain
Ding, S., Royall, J. J., Sunkin, S. M., Ng, L., Facer, B. A. C., Lesnar, P., Guillozet‐Bongaarts, A., McMurray, B., Szafer, A., Dolbeare, T. A., et al. (2016) · Journal of Comparative Neurology · doi:10.1002/cne.24080 · Cited by 447
Neuroanatomical correlates of brainstem coma
Parvizi, J. (2003) · Brain · doi:10.1093/brain/awg166 · Cited by 400 · cited 1×
“Evidence that the AAn is essential for consciousness comes from experimentally induced lesions in rodents(3) and cats(4) and mapping of brainstem infarctions in humans.(5) In traumatic coma, however, up to 44% of patients may not have visible brainstem pathology on conventional MRI sequences.”
Background
Cited by
Sorted by citations
Recovery from disorders of consciousness: mechanisms, prognosis and emerging therapies
Edlow, B. L., Claassen, J., Schiff, N. D., & Greer, D. M. (2020) · Nature Reviews Neurology · doi:10.1038/s41582-020-00428-x · Cited by 782
Self-citationThe ascending arousal system shapes neural dynamics to mediate awareness of cognitive states
Munn, B., Müller, E. J., Wainstein, G., & Shine, J. M. (2021) · Nature Communications · doi:10.1038/s41467-021-26268-x · Cited by 188
Provencio, J. J., Hemphill, J. C., Claassen, J., Edlow, B. L., Helbok, R., Vespa, P. M., Diringer, M. N., Polizzotto, L., Shutter, L., Suarez, J. I., et al. (2020) · Neurocritical Care · doi:10.1007/s12028-020-01028-9 · Cited by 146
Self-citationThe feasibility of artificial consciousness through the lens of neuroscience
Aru, J., Larkum, M. E., & Shine, J. M. (2023) · Trends in Neurosciences · doi:10.1016/j.tins.2023.09.009 · Cited by 98
The neuroethics of disorders of consciousness: a brief history of evolving ideas
Young, M. J., Bodien, Y. G., Giacino, J. T., Fins, J. J., Truog, R. D., Hochberg, L. R., & Edlow, B. L. (2021) · Brain · doi:10.1093/brain/awab290 · Cited by 95
Self-citationUpdate on neuroimaging in disorders of consciousness
Sanz, L. R. D., Thibaut, A., Edlow, B. L., Laureys, S., & Gosseries, O. (2021) · Current Opinion in Neurology · doi:10.1097/wco.0000000000000951 · Cited by 80
Self-citationMRI in disorders of consciousness
Snider, S. B., & Edlow, B. L. (2020) · Current Opinion in Neurology · doi:10.1097/wco.0000000000000873 · Cited by 79
Self-citationKondziella, D., Menon, D. K., Helbok, R., Naccache, L., Othman, M., Rass, V., Rohaut, B., Diringer, M. N., Stevens, R. D., Campaign, T. C. C. O. T. C. C., et al. (2021) · Neurocritical Care · doi:10.1007/s12028-021-01246-9 · Cited by 67
Self-citationEdlow, B. L., Barra, M. E., Zhou, D. W., Foulkes, A. S., Snider, S. B., Threlkeld, Z. D., Chakravarty, S., KIRSCH, J. E., Chan, S., Meisler, S. L., et al. (2020) · Neurocritical Care · doi:10.1007/s12028-020-01062-7 · Cited by 64
Self-citationMultimodal MRI reveals brainstem connections that sustain wakefulness in human consciousness
Edlow, B. L., Olchanyi, M., Freeman, H. J., Li, J., Maffei, C., Snider, S. B., Zöllei, L., Iglesias, J. E., Augustinack, J. C., Bodien, Y. G., et al. (2024) · Science Translational Medicine · doi:10.1126/scitranslmed.adj4303 · Cited by 58
Self-citationDisorders of Consciousness Associated With COVID-19
Fischer, D. B., Snider, S. B., Barra, M. E., Sanders, W. R., Rapalino, O., Schaefer, P. W., Foulkes, A. S., Bodien, Y. G., & Edlow, B. L. (2021) · Neurology · doi:10.1212/wnl.0000000000013067 · Cited by 53
Self-citationAscending arousal network connectivity during recovery from traumatic coma
Snider, S. B., Bodien, Y. G., Frau‐Pascual, A., Bianciardi, M., Foulkes, A. S., & Edlow, B. L. (2020) · NeuroImage Clinical · doi:10.1016/j.nicl.2020.102503 · Cited by 47
Self-citationAlnagger, N., Cardone, P., Martial, C., Laureys, S., Annen, J., & Gosseries, O. (2023) · La Presse Médicale · doi:10.1016/j.lpm.2022.104163 · Cited by 41
Olsen, A., Babikian, T., Bigler, E. D., Caeyenberghs, K., Conde, V., Dams-O’Connor, K., Dobryakova, E., Genova, H. M., Grafman, J. H., Haberg, A. K., et al. (2020) · Brain Imaging and Behavior · doi:10.1007/s11682-020-00313-7 · Cited by 37
Clinical Decision on Disorders of Consciousness After Acquired Brain Injury: Stepping Forward
Zheng, R., Qi, Z., Wang, Z., Xu, Z., Wu, X., & Mao, Y. Q. (2022) · Neuroscience Bulletin · doi:10.1007/s12264-022-00909-7 · Cited by 37
Singh, K., García‐Gomar, M. G., Cauzzo, S., Staab, J. P., Indovina, I., & Bianciardi, M. (2022) · Human Brain Mapping · doi:10.1002/hbm.25836 · Cited by 31
Self-citationTranslational approaches to influence sleep and arousal
Brown, R. E., Spratt, T. J., & Kaplan, G. B. (2022) · Brain Research Bulletin · doi:10.1016/j.brainresbull.2022.05.002 · Cited by 31
Edlow, B. L., Bodien, Y. G., Baxter, T., Belanger, H. G., Cali, R. J., Deary, K. B., Fischl, B. R., Foulkes, A. S., Gilmore, N., Greve, D. N., et al. (2022) · Journal of Neurotrauma · doi:10.1089/neu.2022.0030 · Cited by 30
Self-citationBianciardi, M., Izzy, S., Rosen, B. R., Wald, L. L., & Edlow, B. L. (2021) · Neurology · doi:10.1212/wnl.0000000000012192 · Cited by 28
Self-citationThe role of ascending arousal network in patients with chronic insomnia disorder
Gong, L., He, K., Fang, C., Deng, Z., Cheng, K., Zhang, X., Zhou, W., Ou, J., Wang, J., Zhang, B., et al. (2022) · Human Brain Mapping · doi:10.1002/hbm.26072 · Cited by 26
Early Thalamocortical Reperfusion Leads to Neurologic Recovery in a Rodent Cardiac Arrest Model
Guo, Y., Cho, S., Wei, Z., Wang, Q., Modi, H. R., Gharibani, P. M., Lu, H., Thakor, N. V., & Geocadin, R. G. (2022) · Neurocritical Care · doi:10.1007/s12028-021-01432-9 · Cited by 22
In vivo structural connectome of arousal and motor brainstem nuclei by 7 Tesla and 3 Tesla MRI
García‐Gomar, M. G., Singh, K., Cauzzo, S., & Bianciardi, M. (2022) · Human Brain Mapping · doi:10.1002/hbm.25962 · Cited by 22
Self-citationInjury patterns associated with cognitive motor dissociation
Franzova, E., Shen, Q., Doyle, K. W., Chen, J. M., Egbebike, J. A., Vrosgou, A., Carmona, J. C., Grobois, L., Heinonen, G., Velazquez, A. G., et al. (2023) · Brain · doi:10.1093/brain/awad197 · Cited by 22
Tractography-Pathology Correlations in Traumatic Brain Injury: A TRACK-TBI Study
Nolan, A., Petersen, C., Iacono, D., Donald, C. L. M., Mukherjee, P., van der Kouwe, A. J. W., Jain, S., Stevens, A. A., Diamond, B. R., Wang, R., et al. (2021) · Journal of Neurotrauma · doi:10.1089/neu.2020.7373 · Cited by 21
Self-citationTraumatic brain injury and disorders of consciousness
Johnson-Black, P. H., Carlson, J. M., & Vespa, P. M. (2025) · Handbook of clinical neurology · doi:10.1016/b978-0-443-13408-1.00014-2 · Cited by 18
Applications of Advanced MRI to Disorders of Consciousness
Fischer, D. B., Newcombe, V., Fernández‐Espejo, D., & Snider, S. B. (2022) · Seminars in Neurology · doi:10.1055/a-1892-1894 · Cited by 18
Self-citationRecovery of consciousness after acute brain injury: a narrative review
Egawa, S., Ader, J., & Claassen, J. (2024) · Journal of Intensive Care · doi:10.1186/s40560-024-00749-9 · Cited by 17
The role of plasticity in the recovery of consciousness
Bagnato, S. (2022) · Handbook of clinical neurology · doi:10.1016/b978-0-12-819410-2.00020-5 · Cited by 17
Jahi McMath: a new state of disorder of consciousness
Machado, C. (2021) · Journal of Neurosurgical Sciences · doi:10.23736/s0390-5616.20.04939-5 · Cited by 17
Enciso-Olivera, C. O., Ordóñez-Rubiano, E. G., Libreros, R. C., Rivera, D., Zárate-Ardila, C., Rudas, J., Pulido, C., Gómez, F. A., Martínez, D., Guerrero, N., et al. (2021) · Scientific Reports · doi:10.1038/s41598-021-98506-7 · Cited by 16
Maffei, C., Gilmore, N., Snider, S. B., Foulkes, A. S., Bodien, Y. G., Yendiki, A., & Edlow, B. L. (2022) · NeuroImage Clinical · doi:10.1016/j.nicl.2022.103294 · Cited by 16
Self-citationGuo, Y. Q., Cao, B., He, Y., Xie, Q., Liang, Q., Lan, Y., Zhang, M., Qiu, Y., Yu, R., & Huang, R. (2023) · Brain Communications · doi:10.1093/braincomms/fcad069 · Cited by 14
Mesoscale Brain Mapping: Bridging Scales and Modalities in Neuroimaging – A Symposium Review
Marchant, J. K., Ferris, N. G., Grass, D., Allen, M. S., Gopalakrishnan, V., Olchanyi, M., Sehgal, D., Sheft, M., Strom, A., Bilgiç, B., et al. (2024) · Neuroinformatics · doi:10.1007/s12021-024-09686-2 · Cited by 14
Self-citationAutomated MRI Segmentation of Brainstem Nuclei Critical to Consciousness
Olchanyi, M., Augustinack, J. C., Haynes, R. L., Lewis, L. D., Cicero, N. G., Li, J., Destrieux, C., Folkerth, R. D., Kinney, H. C., Fischl, B. R., et al. (2025) · Human Brain Mapping · doi:10.1002/hbm.70357 · Cited by 13
Self-citationFunctional hub disruption emphasizes consciousness recovery in severe traumatic brain injury
Oujamaa, L., Delon‐Martin, C., Jaroszynski, C., Termenón, M., Silva, S., Payen, J., & Achard, S. (2023) · Brain Communications · doi:10.1093/braincomms/fcad319 · Cited by 12
Artificial Intelligence and Machine Learning Applications in Critically Ill Brain Injured Patients
Vitt, J. R., & Mainali, S. (2024) · Seminars in Neurology · doi:10.1055/s-0044-1785504 · Cited by 11
Behavioral scales variability in patients with prolonged disorders of consciousness
Cortese, M. D., Vatrano, M., Arcuri, F., Raso, M. G., Tonin, P., Calabrò, R. S., & Riganello, F. (2023) · Neurological Sciences · doi:10.1007/s10072-023-06812-x · Cited by 11
Bergeron, D., Mithani, K., Raguž, M., Chudy, D., Huang, Y., Hadjinicolaou, A., Iorio‐Morin, C., Fournier‐Gosselin, M., Obaïd, S., Ibrahim, G. M., et al. (2025) · Journal of neurosurgery · doi:10.3171/2025.3.jns241092 · Cited by 9
Advances in neuroimaging in disorders of consciousness
Sala, A., Gosseries, O., Laureys, S., & Annen, J. (2025) · Handbook of clinical neurology · doi:10.1016/b978-0-443-13408-1.00008-7 · Cited by 8
Probabilistic mapping and automated segmentation of human brainstem white matter bundles
Olchanyi, M., Schreier, D. R., Li, J., Maffei, C., Sorby‐Adams, A., Kinney, H. C., Healy, B. C., Freeman, H. J., Shless, J. S., Destrieux, C., et al. (2026) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2509321123 · Cited by 8
Self-citationPrognosis of consciousness disorders in the intensive care unit
Kumar, A., Ridha, M., & Claassen, J. (2023) · La Presse Médicale · doi:10.1016/j.lpm.2023.104180 · Cited by 8
Yang, Y., Cao, T.-Q., He, S., Wang, L., He, Q., Fan, L., Huang, Y., Zhang, H., Wang, Y., Dang, Y., et al. (2024) · Military Medical Research · doi:10.1186/s40779-024-00585-w · Cited by 8
Korneev, A. A., Bukinich, A. M., Matveeva, E. Y., & Akhutina, T. V. (2022) · New Ideas in Child and Educational Psychology · doi:10.11621/nicep.2022.0302 · Cited by 7
Neuroimaging in Disorders of Consciousness and Recovery
Xu, L. B., Hampton, S. E., & Fischer, D. B. (2023) · Physical Medicine and Rehabilitation Clinics of North America · doi:10.1016/j.pmr.2023.06.017 · Cited by 7
Oughourlian, T. C., Tun, G., Antony, K. M., Gupta, A., Mays, V. M., Mayer, E. A., Rapkin, A. J., & Labus, J. S. (2022) · Pain · doi:10.1097/j.pain.0000000000002754 · Cited by 6
Bordin, V., Pirastru, A., Bergsland, N., Cazzoli, M., Baselli, G., & Baglio, F. (2023) · NeuroImage · doi:10.1016/j.neuroimage.2023.120272 · Cited by 6
Korneev, A. A., Bukinich, A. M., Matveeva, E. Y., & Akhutina, T. V. (2022) · Moscow University Psychology Bulletin · doi:10.11621/vsp.2022.01.02 · Cited by 6
Munn, B., Müller, E. J., Wainstein, G., & Shine, J. M. (2021) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2021.03.30.437635 · Cited by 6
Jahi McMath, a New Disorder of Consciousness
Machado, C. (2021) · Revista latinoamericana de bioética · doi:10.18359/rlbi.5635 · Cited by 5
Electrophysiological monitoring of neurological functions at the acute phase of brain injury
Gobert, F., Dailler, F., Rheims, S., André‐Obadia, N., & Balança, B. (2024) · European Journal of Anaesthesiology Intensive Care · doi:10.1097/ea9.0000000000000044 · Cited by 4
Acute encephalopathy in the ICU: a practical approach
Kurtz, P., van den Boogaard, M., Girard, T. D., & Hermann, B. (2024) · Current Opinion in Critical Care · doi:10.1097/mcc.0000000000001144 · Cited by 4
Currieri, T., Falcó-Roget, J., Rostami, E., Vitabile, S., & Crimi, A. (2025) · IEEE Access · doi:10.1109/access.2025.3638875 · Cited by 3
Jung, J. Y., Yoo, Y. J., Yoon, M., Hong, B. Y., Kim, T., Park, G., Lee, J. I., Lee, S., Im, S., & Lim, S. H. (2024) · Frontiers in Neurology · doi:10.3389/fneur.2024.1373750 · Cited by 3
Wang, P., Xiang, J., Niu, Y., Wei, J., Lan, C., Li, X., Xu, L., Yin, Y., Wang, H., Zhang, T., et al. (2024) · Frontiers in Neuroscience · doi:10.3389/fnins.2024.1443478 · Cited by 3
Zhang, J., Wei, L., Zhou, F., Du, Z. Z., Wang, M., Wu, G., Yuan, Q., Xi, C., Yang, W., Fu, P., et al. (2025) · Translational Stroke Research · doi:10.1007/s12975-025-01326-4 · Cited by 3
Xu, C.-X., Zheng, R., Zhou, L.-Y., & Feng, D. (2023) · Heliyon · doi:10.1016/j.heliyon.2023.e15279 · Cited by 3
Machado, C. (2020) · Neurology · doi:10.1212/wnl.0000000000010097 · Cited by 3
Cardile, D., Bonanno, L., Ciurleo, R., & Calabrò, R. S. (2025) · European Journal of Pharmacology · doi:10.1016/j.ejphar.2025.177532 · Cited by 2
Zhu, S., Cao, T., He, Q., Wang, N., Jia, Y., Chai, X., & Yang, Y. (2025) · NeuroImage Clinical · doi:10.1016/j.nicl.2025.103864 · Cited by 2
Update on Disorders of Consciousness
Marino, M. H., Koffer, J., & Nalla, S. (2023) · Current Physical Medicine and Rehabilitation Reports · doi:10.1007/s40141-023-00384-9 · Cited by 2
Emerging Approaches for Regenerative Rehabilitation Following Traumatic Brain Injury
O’Donnell, J. C., Swanson, R. L., Wofford, K. L., Grovola, M. R., Purvis, E. M., Petrov, D., & Cullen, D. K. (2022) · Physiology in health and disease · doi:10.1007/978-3-030-95884-8_13 · Cited by 2
Jellinger, K. A. (2024) · Free Neuropathology · doi:10.17879/freeneuropathology-2025-5982 · Cited by 1
Structural Injuries Are Associated with Better Emotional Well-being after Traumatic Brain Injury
Snider, S. B., Shi, H., Maffei, C., Gilmore, N., Freeman, H. J., Atalay, A. S., Li, J., Yeager, J. A., Kumar, R. G., Yew, B., et al. (2026) · Journal of Neurotrauma · doi:10.1177/08977151261468930 · Cited by 1
Self-citationLicandro, R., Olchanyi, M., da Silva, L. F. F., van der Kouwe, A. J. W., Jaimes, C. E., Ngo, N. X., Kelley, W., Folkerth, R. D., Haynes, R. L., Edlow, B. L., et al. (2025) · Human Brain Mapping · doi:10.1002/hbm.70422 · Cited by 1
Self-citationWang, M., He, Q., Zhu, S., Cao, T., Wang, N., Jia, Y., Wu, H., Liang, J., Niu, H., Xu, Z., et al. (2025) · European Journal of Neurology · doi:10.1111/ene.70476 · Cited by 1
Ružiňák, R., Bittšanský, M., Martiníková, M., Nosáľ, V., Kantorová, E., Ballova, J., Koprušáková, M. T., Hnilicová, P., Grendár, M., Dusenka, R., et al. (2021) · Biomedical Papers · doi:10.5507/bp.2021.029 · Cited by 1
Edlow, B. L., & Snider, S. B. (2020) · Neurology · doi:10.1212/wnl.0000000000010099
Self-citationClinical application of connectomics to disorders of consciousness
Fischer, D. B., Snider, S. B., & Edlow, B. L. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-85280-7.00017-8
Self-citationBeyond behavior : electrophysiological markers of conscious processing
Fló, E. (2024) · theses.fr (ABES) · doi:10.70675/b95a2dc0z20a4z4341za655zb201bba1a18c
Cardiac arrest and disorders of consciousness
Turan, N., & Geocadin, R. G. (2025) · Handbook of clinical neurology · doi:10.1016/b978-0-443-13408-1.00015-4
Advances in understanding and treating disorders of consciousness caused by brainstem injury
He, Q., Zhu, S., Chai, X., Cao, T., Wang, N., & Yang, Y. (2025) · Chinese Neurosurgical Journal · doi:10.1186/s41016-025-00411-9
Zieglgänsberger, D., & Dittrich, T. D. (2026) · Case Reports in Neurology · doi:10.1159/000549865
Colombo, M. A., Derchi, C., Atzori, T., Litterio, E., Arcuri, P., Valota, C., Chieregato, A., Navarro, J., Massimini, M., & Comanducci, A. (2026) · NeuroImage · doi:10.1016/j.neuroimage.2026.121783
Calderone, A., Luca, R. D., Currò, A., Mirabile, A., Piccione, M., & Calabrò, R. S. (2026) · Brain Sciences · doi:10.3390/brainsci16030344
Structural and functional anatomy of the brainstem
Heinsen, H., Grinberg, L. T., & Bohnert, S. (2026) · Handbook of clinical neurology · doi:10.1016/b978-0-443-15736-3.00015-9
Novel diagnostic and therapeutic approaches for patients suffering from disorders of consciousness
Hermann, B. (2019) · theses.fr (ABES) · doi:10.70675/e8620819z412fz4bd4z8475z998a979bfe82
Ma, S., Shi, J., Liu, J., Li, K., Yang, J., Liang, Y., He, J., Fan, X., & Qiao, H. (2026) · Frontiers in Neurology · doi:10.3389/fneur.2026.1786548
Wang, X., Yin, Y., Wang, X., & Wu, S. (2026) · Frontiers in Neurology · doi:10.3389/fneur.2026.1797576
Yu, Z., Lin, W., Cao, Z., Chu, Y., He, L., Chen, N., lv, J., Tang, Y., Ji, X., Tang, X., et al. (2026) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000001186
Edlow, B. L., Barra, M. E., Schreier, D. R., Fecchio, M., Freeman, H. J., Li, J., Lawrence, P. K., Sanders, W. R., Meydan, A., Atalay, A. S., et al. (2026) · medRxiv · doi:10.64898/2026.08.20.26359720
Self-citationNeurostimulants for disorders of consciousness in the intensive care unit: A systematic review
Gunther, M. G., Tran, N., Prothro, K. P., Huddleston, B. S., & Jiang, S. (2026) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2026.08.012
Metadata
- Authors
- Snider, S. B., Bodien, Y. G., Bianciardi, M., Brown, E. N., Wu, O., & Edlow, B. L.
- Affiliations
- Harvard University (US)
- Venue
- Neurology
- Published
- 2019-09-24
- Volume
- 93
- Issue
- 13
- Pages
- e1281-e1287
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- PMC
- PMC7011864
- OpenAlex
- W2972034337
- Semantic Scholar
- dec047f02766750c1a9a89e6712bdfd990904640
- Cited by
- 83
- References
- 18
- Citations by year
- 2026: 11 · 2025: 12 · 2024: 11 · 2023: 12 · 2022: 15 · 2021: 12 · 2020: 9 · 2019: 1
- FWCI
- 6.17
- Type
- journal article
- Language
- en
- Open access
- green
- pmc.ncbi.nlm.nih.gov
- Locations
- Neurology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion)
- Funders
- National Institute of General Medical Sciences (R01GM104948, P01GM118269)
- National Institute of Neurological Disorders and Stroke (K23NS094538)
- National Institute of Biomedical Imaging and Bioengineering (K01EB019474)
- National Center for Chronic Disease Prevention and Health Promotion (U48 DP000039)
- Topics
- Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury Research
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced Neuroimaging Techniques and Applications
- Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury and Neurovascular Disturbances
- Keywords
- traumatic coma, disorders of consciousness, traumatic brain injury, hypothalamus, thalamus, connectivity probability, white matter integrity, diffusion tractography
- MeSH terms
- Brain Injuries, Traumatic, Adult, Arousal, Brain Injuries, Brain Stem, Consciousness, Female, Humans, Male, Neural Pathways, Thalamus, Basal Forebrain
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-11-11, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-11-11 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
