Locked in state. A clinicopathological study

Two patients developed the locked-in state characterised by quadriplegia and mutism with an alert sensorium. Initially they had mild dysarthria and uncrossed hemisensory or hemimotor deficits involving the face and ipsilateral extremities. Both patients died. Rostral brainstem infarctions were found at autopsy in them. Acute onset of uncrossed hemisensory and hemimotor deficits with dysarthria may be caused by infarction of the pons which may predispose to locked-in state.