Traumatic brain injury to brainstem/thalamic/hypothalamic/basal-forebrain arousal nuclei is implicated in the pathogenesis of coma. However, due to difficulty in localizing these nuclei with conventional MRI, it is unknown which lesioned nuclei cause coma, and which are compatible with recovery of arousal/consciousness. We mapped our recently developed brainstem arousal-nuclei atlases and current thalamic/hypothalamic/basal-forebrain atlases to 3Tesla susceptibility-weighted-images in twelve acute traumatic-coma patients, who recovered full arousal/consciousness within six-months. We identified multiple combinations of injured brainstem/thalamic arousal-nuclei that cause acute coma, yet are compatible with a full recovery of arousal/consciousness. Thus, there is redundancy and resiliency of arousal mechanisms in traumatic coma.
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