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Pontine gliomas causing locked-in syndrome
H Masuzawa1, J Sato, H Kamitani
1Department of Neurosurgery, Kanto Teishin Hospital, Toyko, Japan.
Summary
Children with terminal pontine glioma often remain conscious in a locked-in state, exhibiting awareness until near death. This presents ethical dilemmas regarding life support decisions for pediatric brain tumor patients.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Clinical Neurology
Background:
- Pontine gliomas are aggressive brain tumors affecting children.
- The terminal phase of these tumors is often associated with altered consciousness.
Observation:
- Retrospective review of 8 pediatric patients with pontine glioma.
- Analysis focused on neurological status and terminal phase characteristics.
Findings:
- All patients developed mutism, quadriplegia, and cranial nerve palsies.
- One adolescent exhibited classic locked-in syndrome for 4 months.
- Younger children, though semicomatose, showed responsiveness via blinking/eye movements, suggesting wakefulness.
Implications:
- Patients may remain conscious and aware in a locked-in state until death.
- This raises significant ethical considerations for intubation and mechanical ventilation decisions in pediatric palliative care.