Instrumental methods in the diagnostics of locked-in syndrome

Kotchoubey, Boris; Lotze, Martín

doi:10.3233/rnn-120249

Cited by 18 publications

(33 citation statements)

References 78 publications

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“…MRI, which is reported to be the most sensitive method in diagnosis of structural disorders in LIS, was not performed until week six, shortly after the patient's admission to inpatient rehabilitation. It has been reported that MRI can reveal a distinct lesion that was not visualized on CT and is particularly important for cases of nonvascular etiology, as in this case of traumatic etiology [10]. The MRI cleared the patient for SCI damage and showed a small pontine injury.…”

Section: Discussionmentioning

confidence: 85%

“…Imaging was performed early on in the patient's course of care; however, the initial CT showed no lesion associated with the ventral pons. This CT was performed without contrast and arguably too early to show the corresponding lesion associated with LIS [10]. MRI, which may have been more sensitive in detecting the lesion, was not performed until week six after injury with no reports as to why this was not performed in the acute care hospital.…”

Section: Discussionmentioning

confidence: 99%

“…This CT was performed without contrast and arguably too early to show the corresponding lesion associated with LIS. Kotchoubey and Lotze reported 22 patients with severe occlusive defect of the basilar artery in which CT did not show any pathological changes during the acute stage, reporting that hypodensity typically cannot be seen until 2 weeks after the infarct [10]. MRI, which is reported to be the most sensitive method in diagnosis of structural disorders in LIS, was not performed until week six, shortly after the patient's admission to inpatient rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

“…The pupillary light reflex was intact. This reflex descends to the pretectal area in the midbrain before reaching the oculomotor nucleus and achieving its motor output [10]. An intact pupillary light reflex indicated the lesion was likely below the midbrain.…”

Section: Differential Considerationsmentioning

confidence: 99%

“…The total variety describes a patient with no voluntary movement and closed eyes [9]. Despite the lack of apparent awareness in these patients, indications of conscious mental activity have been shown through use of technology such as EEG, which can correlate brain activity in relation to stimuli [10]. …”

Section: Introductionmentioning

confidence: 99%

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Differential Diagnosis and Management of Incomplete Locked-In Syndrome after Traumatic Brain Injury

Surdyke

Fernandez

Foster

et al. 2017

Case Reports in Neurological Medicine

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Locked-in syndrome (LIS) is a rare diagnosis in which patients present with quadriplegia, lower cranial nerve paralysis, and mutism. It is clinically difficult to differentiate from other similarly presenting diagnoses with no standard approach for assessing such poorly responsive patients. The purpose of this case is to highlight the clinical differential diagnosis process and outcomes of a patient with LIS during acute inpatient rehabilitation. A 32-year-old female was admitted following traumatic brain injury. She presented with quadriplegia and mutism but was awake and aroused based on eye gaze communication. The rehabilitation team was able to diagnose incomplete LIS based on knowledge of neuroanatomy and clinical reasoning. Establishing this diagnosis allowed for an individualized treatment plan that focused on communication, coping, family training, and discharge planning. The patient was ultimately able to discharge home with a single caregiver, improving her quality of life. Continued evidence highlights the benefits of intensive comprehensive therapy for those with acquired brain injury such as LIS, but access is still limited for those with a seemingly poor prognosis. Access to a multidisciplinary, specialized team provides opportunity for continued assessment and individualized treatment as the patient attains more medical stability, improving long-term management.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Differential Considerationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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