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Reverse Locked-In Syndrome.

Pooja Raibagkar1, Ram V Chavali2, Tamara B Kaplan1

  • 1Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

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|March 22, 2017
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Summary
This summary is machine-generated.

A new stroke syndrome, "reverse locked-in syndrome," is described, characterized by preserved consciousness and motor function but with eye paralysis after basilar artery recanalization. This condition presents opposite deficits to locked-in syndrome.

Keywords:
Endovascular thrombectomyLocked-in syndromeMidbrain tegmentumOphthalmoparesisTop of the basilar artery

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Area of Science:

  • Neurology
  • Stroke Medicine
  • Neuroimaging

Background:

  • Basilar artery occlusion can lead to locked-in syndrome, a condition of severe paralysis with preserved consciousness.
  • Endovascular recanalization is a critical treatment for acute basilar artery occlusion.

Observation:

  • A patient with basilar artery occlusion presented with coma and quadriplegia, treated with endovascular thrombectomy.
  • Post-procedure, the patient regained consciousness and limb movement but developed bilateral ptosis and complete oculomotor paralysis.

Findings:

  • Neuroanatomic localization via MRI revealed infarction of the bilateral oculomotor nuclei in the midbrain tegmentum.
  • The patient's condition, termed "reverse locked-in syndrome," presented opposite deficits to classic locked-in syndrome.

Implications:

  • This case highlights a rare neurological deficit following successful basilar artery recanalization.
  • "Reverse locked-in syndrome" is characterized by ophthalmoplegia and ptosis with preserved consciousness and motor function.
  • Understanding this syndrome aids in diagnosing and managing complex stroke outcomes.