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Locked-in syndrome: a case report

F Budak¹, A Ilhan, M Ozmenoğlu

¹Department of Neurology, KTU Medical School, Trabzon, Turkey.

Clinical EEG (Electroencephalography)

|January 1, 1994

Summary

A man experienced locked-in syndrome caused by a ventral pontine infarction. Brain imaging confirmed the lesion, while electrophysiological tests remained normal, highlighting a specific neurological presentation.

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Area of Science:

Neurology
Neuroimaging
Electrophysiology

Background:

Locked-in syndrome is a rare neurological condition characterized by complete paralysis of voluntary muscles except for vertical eye movements.
Ventral pontine infarction, a type of stroke affecting the pons, can lead to severe neurological deficits.

Observation:

A 46-year-old male presented with symptoms consistent with locked-in syndrome.
Magnetic Resonance Imaging (MRI) revealed abnormal signal intensities specifically in the ventral pons region.
Routine electroencephalography (EEG), brainstem auditory evoked potentials (BAEPs), and somatosensory evoked potentials (SEPs) were performed.

Findings:

The MRI findings localized the cause of the patient's condition to the ventral pons.
Despite the severe motor impairment indicative of locked-in syndrome, the EEG, BAEPs, and SEPs were all within normal limits.
This suggests that the infarction primarily affected motor pathways in the ventral pons without significantly impacting the analyzed sensory and cortical functions.

Implications:

This case highlights the importance of neuroimaging in diagnosing the specific etiology of locked-in syndrome.
The normal electrophysiological tests in the presence of a clear pontine lesion underscore the selective nature of the vascular insult.
Further research may elucidate the precise pathways affected and the implications for prognosis and management in similar cases.

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