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Ischaemic pontomedullary transection with incomplete locked-in syndrome. A case report with MRI

N Latronico1, A Tansini, G F Gualandi

  • 1Department of Anesthesiology-Intensive Care, University of Brescia, Italy.

Neuroradiology
|January 1, 1993
PubMed

Insights

We report a rare case of incomplete locked-in syndrome caused by a basilar artery clot. MRI confirmed a pontomedullary junction infarct, suggesting the lower reticular formation isn't vital for consciousness.

Area of Science:

  • Neuroscience
  • Neurology
  • Vascular Neurology

Background:

  • Locked-in syndrome (LIS) is a rare neurological condition characterized by paralysis and inability to communicate, while consciousness is preserved.
  • Basilar artery thrombosis can lead to severe neurological deficits, including brainstem strokes affecting consciousness and motor function.

Observation:

  • A case of incomplete locked-in syndrome (LIS) is presented, resulting from basilar artery thrombosis.
  • Magnetic Resonance Imaging (MRI) revealed a complete and sharply demarcated infarct specifically at the pontomedullary junction.

Findings:

  • The pontomedullary junction infarct, despite its location, was associated with incomplete LIS, indicating preserved consciousness.
  • This clinical observation aligns with experimental data suggesting the lower reticular formation's non-critical role in maintaining consciousness.

Implications:

  • This case represents the first reported instance of ischemic pontomedullary transection leading to locked-in syndrome.
  • The findings challenge traditional understanding of consciousness pathways and highlight the brainstem's complex role in awareness and motor control.
  • Further research into brainstem stroke syndromes and consciousness is warranted.

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