Locked-in syndrome following cervical manipulation

A case of locked-in syndrome following cervical manipulation in a 36-year-old woman is described. The patient had always been healthy but was born with polydactyly on one hand and had 2 mentally retarded children with progressive leucoencephalopathia. Because of pain in the neck the patient was treated with cervical manipulation, during which she became ill and developed a locked-in syndrome, where she was awake but mutistic and totally paralyzed. Following intensive training the patient became able to perform rocking movements with the head, which were used to activate an electronic system for communication. MR scanning 3 months after admission exhibited a sharply demarcated triangular area stretching through most of the pons, which was compatible with a recent infarction.