Summary
Chronic intermittent bipolar electrical stimulation of the left nucleus reticulatus polaris thalami was performed in a patient in a state of subcoma due to ischaemic infarction of wide medial parts of the midbrain, mainly the tegmentum, and the right-sided mediobasal parts of the forebrain. Stimulation immediately resulted in autonomic reactions and behavioural arousal reactions during the periods of stimulation. Longterm effect consisted of a rise in the level of clinical responsiveness for a period of seven weeks. A preexistent severe pneumonia disappeared completely after one week of stimulation and returned after seven weeks. The results are discussed on the basis of the pathoanatomical findings and of the physiological functions of the damaged as well as of the stimulated areas.
Similar content being viewed by others
References
Chase, T. N., Moretti, L., Prensky, A. L., Clinical and electro-encephalographic manifestations of vascular lesions of the pons. Neurology18 (1968), 357–368.
Duensing, F., Das Elektroenzephalogramm bei Störungen der Bewußtseinslage. Arch. Psychiat. Nervenkr.183 (1949), 71–115.
French, J. D., von Amerongen, F. K., Magoun, H. W., An activating system in brain stem of monkey. Arch. Neurol. (Chic.)68 (1952), 577–590.
Hassler, R., Anatomy of the Thalamus. In: Introduction to stereotaxis with an atlas of the human brain. Eds.: Schaltenbrand, G., and Bailey, P., Vol. 1, pp. 230–290. Stuttgart: G. Thieme. 1959.
Hassler, R., Dalle Ore, G., Dieckmann, G., Bricolo, A., Dolce, G., Behavioural and EEG arousal induced by stimulation of unspecific projection system in a patient with post-traumatic apallic syndrome. Electroenceph. clin. Neurophysiol.27 (1969), 306–310.
Hassler, R., Dalle Ore, G., Bricolo, A., Dieckmann, G., Dolce, G., EEG and clinical arousal induced by bilateral long-term stimulation of pallidal system in traumatic vigil coma. Electroenceph. clin. Neurophysiol.27 (1969), 689–690.
Hassler, R., Regulation der psychischen Aktivität. In: Forschung und Information, Bd. 10, pp. 27–35, Hirnforschung und Psychiatrie. Hrsg.: O. W. Haseloff. Berlin: Colloquium Verlag. 1971.
Hassler, R., Der Notfall: Bewußtlosigkeit. III. Wuppertaler Notfallsymposion 1972, pp. 1–13. Hrsg.: H. J. Streicher and J. Rolle. Stuttgart: G. Thieme. 1972.
Hess, R., Jr., Akert, K., Koella, W. P., Les potentiels bioélectriques du cortex et du thalamus et leur altération par stimulation du centre hypnique chez le chat. Rev. Neurol.83 (1950), 537–544.
Jellinger, K., Pathology and pathogenesis of apallic syndrome following closed head injuries. In: Dalle Ore, G., Gerstenbrand, F., Lücking, C. H., Peters, G., Peters, U. H. (eds.), The apallic syndrome. Psychiatry Series 1977.
Lindenberg, R., Die Gefäßversorgung und ihre Bedeutung für Art und Ort von kreislaufbedingten Gewebsschäden und Gefäßprozessen. In: Lubarsch, O., Henke, F., Rössle, R. (eds.), Handbuch der spez. path. Anat. Histol.XIII/1 B (1957), 1071–1164.
Lindsley, D. B., Bowden, J. W., Magoun, H. W., Effect upon the EEG of acute injury to the brain stem activating system. Electroenceph. Clin. Neurophysiol.1 (1949), 475–486.
Lindsley, D. B., Schreiner, L. H., Knowles, W. B., Magoun, H. W., Behavioral and EEG changes following chronic brain stem lesions in the cat. Electroenceph. Clin. Neurophysiol.2 (1950), 483–498.
McLardy, R., Ervin, F., Mark, V., Scoville, W., Sweet, W., Attempted insetelectrodes-arousal from traumatic coma: Neuropathological findings. Trans. Amer. neurol. Ass.93 (1968), 25–30.
Moruzzi, G., Magoun, H. W., Brain stem reticular formation and activation of the EEG. Electroenceph. Clin. Neurophysiol.1 (1949), 455–473.
Neundörfer, B., Meyer-Wahl, L., Meyer, J. G., Alpha-EEG und Bewußtlosigkeit. Ein kasuistischer Beitrag zur lokaldiagnostischen Bedeutung des α-EEG beim bewußtlosen Patienten. Z. EEG-EMG5 (1974), 106–114.
Riechert, T., Mundinger, F., Beschreibung und Anwendung eines Zielgerätes für stereotaktische Hirnoperationen (II. Modell). Acta Neurochir. (Wien), Suppl. III (1955), 308–337.
Schaltenbrand, G., Bailey, P., Introduction to Stereotaxis with an atlas of the human brain (Vol. II). Stuttgart: G. Thieme. 1959.
Szirmai, J., Guseo, A., Molnár, M., Bilateral symmetrical softening of the thalamus. J. Neurol.217 (1977), 57–65.
Ule, G., Laux, W., Lohmann, H. J., Anoetischer Symptomenkomplex und apallisches Syndrom bei der diffusen Form der multiplen Sklerose. Akt. Fragen d. Psychiat. Neurol., Vol. 2, pp. 168–174. Basel-New York: Karger. 1965.
Yaşargil, M. G., Antic, J., Laciga, R., Jain, K. K., Hodosh, R. M., Smith, R. D., Microsurgical pterional approach to aneurysms of the basilar bifurcation. Surg. Neurol.6 (1976), 83–91.
Author information
Authors and Affiliations
Additional information
Dedicated to Prof. H. Penzholz on the occasion of his 65th birthday.
Rights and permissions
About this article
Cite this article
Sturm, V., Kühner, A., Schmitt, H.P. et al. Chronic electrical stimulation of the thalamic unspecific activating system in a patient with coma due to midbrain and upper brain stem infarction. Acta neurochir 47, 235–244 (1979). https://doi.org/10.1007/BF01406406
Issue Date:
DOI: https://doi.org/10.1007/BF01406406