Favorable Outcome From A Locked-In State Despite Extensive Pontine Infarction By MRI
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- Samaniego, E.A., Lansberg, M.G., DeGeorgia, M. et al. Neurocrit Care (2009) 11: 369. doi:10.1007/s12028-009-9268-y
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Outcome prediction of patients who are in a locked-in state is challenging. Extensive pontine infarction on diffusion weighted imaging MRI (DWI) has been proposed as a poor prognosticator. We report on three patients with a locked-in state with unexpected favorable recoveries despite DWI evidence of widespread pontine ischemia.
Report of three cases.
Three young patients (32-, 30-, and 16-years-old) presented with a locked-in state caused by pontine infarction. The first patient did not receive any acute stroke therapies, the second patient underwent endovascular therapy 20 h after symptom onset resulting in partial recanalization of the basilar artery, and the third patient progressed to a locked-in state despite having received intravenous tissue plasminogen activator. The DWI of all three patients demonstrated acute and widespread pontine infarction involving more than two-thirds of the pons. Two patients regained full independence in their activities of daily living. The third patient remained wheelchair bound, but lives with her family, eats independently, uses a typewriter and wrote a book.
Patients who are in a locked-in state may have substantial functional recovery despite DWI evidence of extensive pontine infarction.