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Transauricular Vagus Nerve Stimulation and Electroencephalographic Assessment in Disorders of Consciousness

Transauricular Vagus Nerve Stimulation and Electroencephalographic Assessment in Disorders of Consciousness

Published on: July 11, 2025

Unlocking the 'locked-in syndrome'.

Mano Shanmuganathan¹, Charles P Warlow, Rustam Al-Shahi Salman

¹Department of Neurosurgery, Western General Hospital, Edinburgh, UK. manoshanmuganathan@nhs.net

British Journal of Neurosurgery

|February 18, 2011

Summary

A man with locked-in syndrome was diagnosed with a petrous apex dural arteriovenous fistula causing brainstem venous hypertension. Surgical clipping resulted in full neurological recovery, highlighting this rare condition.

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Area of Science:

Neurology
Neurosurgery
Vascular Imaging

Background:

Brainstem stroke is a critical diagnosis with significant morbidity.
Locked-in syndrome presents as severe immobility with preserved consciousness.
Petrous apex dural arteriovenous fistulas are rare vascular malformations.

Observation:

A 48-year-old male presented with symptoms mimicking a brainstem stroke, leading to a clinical diagnosis of locked-in syndrome.
Initial investigations were insufficient to identify the underlying cause of the patient's neurological deficits.

Findings:

Advanced imaging revealed a petrous apex dural arteriovenous fistula as the cause of the patient's condition.
The fistula induced profound venous hypertension within the brainstem, explaining the neurological symptoms.

Implications:

This case underscores the importance of considering rare vascular etiologies in patients presenting with locked-in syndrome.
Surgical intervention, specifically clipping of the fistula, can lead to complete neurological recovery.
Accurate diagnosis and timely management of petrous apex dural arteriovenous fistulas are crucial for favorable patient outcomes.