Locked-in Syndrome Due to Metastatic Pontomedullary Tumor-Case Report-

İnci, Servet; Özgen, Tunçalp

doi:10.2176/nmc.43.497

Cited by 15 publications

(4 citation statements)

References 25 publications

(25 reference statements)

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“…Acute ventral pontine lesions are the most common cause of the quadriplegia that characterizes LIS, with patients exhibiting total large-fiber deafferentation and deefferentation below the neck. These individuals are classically described as being “trapped” within their paralyzed bodies (Bauer et al, 1979 ; Inci and Ozgen, 2003 ; Laureys et al, 2005 ). Obviously, sensations from the body constitute a major element of the experience of awareness.…”

Section: Corporeal State Awareness In An Insentient and Unmoving Physmentioning

confidence: 99%

Towards multiple interactions of inner and outer sensations in corporeal awareness

Lucci

Pazzaglia

2015

Front. Hum. Neurosci.

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Under normal circumstances, different inner- and outer-body sources are integrated to form coherent and accurate mental experiences of the state of the body, leading to the phenomenon of corporeal awareness. How these processes are affected by changes in inner and outer inputs to the body remains unclear. Here, we aim to present empirical evidence in which people with a massive sensory and motor disconnection may continue to experience feelings of general body state awareness without complete control of their inner and outer states. In these clinical populations, the activity of the neural structures subserving inner and outer body processing can be manipulated and tuned by means of body illusions that are usually based on multisensory stimulation. We suggest that a multisensory therapeutic approach could be adopted in the context of therapies for patients suffering from deafferentation and deefferentation. In this way, these individuals could regain a more complete feeling and control of the sensations they experience, which vary widely depending on their neurological condition.

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Section: Corporeal State Awareness In An Insentient and Unmoving Physmentioning

confidence: 99%

Towards multiple interactions of inner and outer sensations in corporeal awareness

Lucci

Pazzaglia

2015

Front. Hum. Neurosci.

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“…• Aneurysm [43][44][45] /vascular malformation 37,40,42,46,47 of the basilar artery • Artery dissection 10,33,[48][49][50][51] (e.g. due to cervical manipulation [52][53][54][55] • Basilar artery vasospasm 56 • Basilar migraine 57 • Central pontine myelinolysis [58][59][60] • Cocaine abuse 61 • Hyperhomocysteinemia 62 • Infection [63][64][65] mechanical brain herniation [66][67][68][69][70] • Multiple sclerosis [71][72][73] • Pontine abscess 74 • Primary 75,76 or metastatic [77][78][79] tumour • Prolonged hypoglycemia 80 • SARS-CoV-2 81,82 • Traumatic brain injury (axonal injury, 12,[83][84]…”

Section: Aetiologies Leading To Infarction/other Damage Of the Ponsmentioning

confidence: 99%

Locked-in syndrome revisited

Schnetzer

McCoy

Bergmann

et al. 2023

Ther Adv Neurol Disord

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The locked-in syndrome (LiS) is characterized by quadriplegia with preserved vertical eye and eyelid movements and retained cognitive abilities. Subcategorization, aetiologies and the anatomical foundation of LiS are discussed. The damage of different structures in the pons, mesencephalon and thalamus are attributed to symptoms of classical, complete and incomplete LiS and the locked-in plus syndrome, which is characterized by additional impairments of consciousness, making the clinical distinction to other chronic disorders of consciousness at times difficult. Other differential diagnoses are cognitive motor dissociation (CMD) and akinetic mutism. Treatment options are reviewed and an early, interdisciplinary and aggressive approach, including the provision of psychological support and coping strategies is favoured. The establishment of communication is a main goal of rehabilitation. Finally, the quality of life of LiS patients and ethical implications are considered. While patients with LiS report a high quality of life and well-being, medical professionals and caregivers have largely pessimistic perceptions. The negative view on life with LiS must be overthought and the autonomy and dignity of LiS patients prioritized. Knowledge has to be disseminated, diagnostics accelerated and technical support system development promoted. More well-designed research but also more awareness of the needs of LiS patients and their perception as individual persons is needed to enable a life with LiS that is worth living.

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“…The most common aetiologies of LiS are either ischemic infarction or haemorrhage in the vertebrobasilar artery territory 4 but mechanical brainstem herniation, 5 aortic dissections, 6 invasive fungal rhinosinusitis, 7 primary 8 or metastatic 9 brainstem tumour, pneumococcal meningitis, 10 basilar migraine 11 and others have been reported. Recently, LiS cases were associated with the COVID-19 disease.…”

Section: Introductionmentioning

confidence: 99%

The vascular locked-in and locked-in-plus syndrome: A retrospective case series

Schnetzer,

Steinbacher,

Bauer

et al. 2023

Ther Adv Neurol Disord

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The locked-in syndrome (LiS) is defined as the loss of most voluntary muscle movements with preserved cognitive abilities due to a ventral pontine lesion. However, some patients may also have severe impairment of consciousness [locked-in plus syndrome (LiPS)]. Here we aimed to explore structural differences between LiS and LiPS patients of vascular aetiology, focusing on lesion patterns and locations to better delineate the clinical spectrum of LiS and LiPS. In this retrospective case series study, we report nine patients (two women), ages 29–74 years (median 50) with LiS and LiPS who were diagnosed between 2007 and 2021. Clinical parameters, MRI findings including the lesioned structures, and a shape feature calculation are presented for every patient. The lesioned structures were determined by a senior neuroradiologist. Two of nine patients had fully retained consciousness (LiS) and seven showed various degrees of impaired consciousness (LiPS). Lesions of LiS patients are round and confined to the pons, whereas lesions of LiPS patients are more elongated and reach neighbouring areas such as the mesencephalon, thalamus or ascending reticular activating system. Lesions involving the mesencephalon and the thalamus are strong indicators of LiPS, whereas for lesions restricted to the pons, the dorsal extension and the associated damage to the ascending reticular activating system are crucial to differentiate LiS from LiPS. Recognizing LiPS using clinical and radiological findings is important as these patients may need different therapies and care and, most importantly, should not be mistaken as unresponsive wakefulness syndrome.

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Locked-in Syndrome Due to Metastatic Pontomedullary Tumor-Case Report-

Cited by 15 publications

References 25 publications

Towards multiple interactions of inner and outer sensations in corporeal awareness

Towards multiple interactions of inner and outer sensations in corporeal awareness

Locked-in syndrome revisited

The vascular locked-in and locked-in-plus syndrome: A retrospective case series

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