Favorable Outcome From A Locked-In State Despite Extensive Pontine Infarction By MRI
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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.
- Smith E, Delargy M. Locked-in syndrome. BMJ. 2005;330(7488):406–9. CrossRef
- du Mesnil de Rochemont R, et al. Magnetic resonance imaging in basilar artery occlusion. Arch Neurol. 2002;59(3):398–402. CrossRef
- Cho TH, et al. Brain stem diffusion-weighted imaging lesion score: a potential marker of outcome in acute basilar artery occlusion. AJNR Am J Neuroradiol. 2009;30(1):194–8. CrossRef
- Plum F, Posner JB. The diagnosis of stupor and coma. Contemp Neurol Ser. 1972;10:1–286.
- Haig AJ, Katz RT, Sahgal V. Mortality and complications of the locked-in syndrome. Arch Phys Med Rehabil. 1987;68(1):24–7.
- Wijdicks EF, Miller GM. Transient locked-in syndrome after uncal herniation. Neurology. 1999;52(6):1296–7.
- Cabezudo JM, et al. Recovery from locked-in syndrome after posttraumatic bilateral distal vertebral artery occlusion. Surg Neurol. 1986;25(2):185–90. CrossRef
- Virgile RS. Locked-in syndrome. Case and literature review. Clin Neurol Neurosurg. 1984;86(4):275–9. CrossRef
- McCusker EA, et al. Recovery from the ‘locked-in’ syndrome. Arch Neurol. 1982;39(3):145–7.
- Patterson JR, Grabois M. Locked-in syndrome: a review of 139 cases. Stroke. 1986;17(4):758–64.
- Kidwell CS, et al. Thrombolytic reversal of acute human cerebral ischemic injury shown by diffusion/perfusion magnetic resonance imaging. Ann Neurol. 2000;47(4):462–9. CrossRef
- Favorable Outcome From A Locked-In State Despite Extensive Pontine Infarction By MRI
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