Locked-in syndrome

Locked-in syndrome is one of the brainstem stroke syndromes and can occur as a result of a pontine stroke that damages the ventral brainstem and pyramidal bundles and corticobulbar tracts 5.

Individuals who are "locked-in" are conscious with preserved cognitive function but can not move or communicate due to the complete paralysis of all voluntary muscles of the body including those of respiration, requiring mechanical ventilation.

As the stroke spares the midbrain and therefore the oculomotor nerve, affected individuals can open his/her eyes and vertical eye movements are preserved 5

The most common cause of ventral pontine damage is basilar artery thrombosis. Other causes include but trauma or cardiocirculatory failure. 

Non-contrast CT may show hypodensity of the ventral portion of the pons.

CT angiography allows to evaluate the cerebral vessels and in particular to look for a defect of enhancement of the basilar artery.

For all health professionals, including the radiology staff encountering ICU patients transported for imaging, the practical application is in part to assume that, until proven otherwise, that all patients in ICU are aware of you, what you say, and their surroundings. 

Stroke and intracranial haemorrhage
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Article information

rID: 24643
Section: Syndromes
Synonyms or Alternate Spellings:
  • Pseudocoma
  • Locked in syndrome

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Cases and figures

  • Case 2: pontine hemorrhage
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