BAER, EOG, MRI and 3-D MR angiography correlates in a case of Locked-In syndrome

A case of Locked-in syndrome is reported with correlation of BAER and EOG with MRI for localization and identification of brain lesions, and 3-D MRA and 2-D gradient echo MR imaging, a non-invasive new diagnostic modality for confirmation and visualization of vascular pathology. There was thrombosis of the basilar artery with extensive infarct of ventral pons and lower mid-brain. The patient had ocular bobbing. This eye movement in its classical form consists of irregular vertical oscillations, the fast component being downward with complete absence of horizontal eye movements. To our knowledge, the change from ocular bobbing to upbeat nystagmus has not been previously reported in the Locked-in syndrome. Bilateral involvement of the lateral lemniscus might have contributed to its appearance in our patient.