‘Locked‐in syndrome’ for 27 years following a viral illness

Abstract

We describe a man who, after a presumed encephalitic illness, was "locked-in" for 27 years. His CT and autopsy findings showed atrophy of the brainstem and a cystic lesion at the base of the pons. He survived longer than most other patients in a similar state.

Persistence of distal motor control in the locked in syndrome. Review of 11 patients

“…The follow-up of this group ranges from 6 months to 8 years. These patients fall into groups one and two (minimal or no recovery) as defined by Patterson and Grabois.15 Four patients (7)(8)(9)(10)(11) achieved notable recovery of motor function, allowing independent gait in three and upper limb One patient (4) had undoubtedly voluntary blinking but very poor reflex blinking and no ocular movement in any direction. Vertical paralysis and/or visual dis order probably existed but communication did not allow better study.…”

“…Transient LIS (patients [8][9][10][11] Four patients had moderate or good recovery. One presented at the onset with an incomplete LIS.…”

“…Polysomnographia was performed in five patients, three times in chronic patients, (4)(5)(6) once during the evolution of the illness (10) and once after satisfactory motor function had returned (11). The results are summarised in Table 2.…”

Clinical and Magnetic Resonance Imaging Findings in a Patient with “Locked‐in” Syndrome

“…Other cases of PPA have been reported [2,3]. Magnetic resonance imaging (MRI) and computed tomography (CT) are oflimited diagnostic value in PPA, whereas single-photon emission computed tomography (SPECT) and positron emission tomography (PET) have shown focal blood flow and metabolic abnormalities in the left temporoparietal region [4][5][6] or left frontal region [7]. In the present patient with PPA, CT and MRI showed generalized atrophy.…”

“…The "locked-in" syndrome is most commonly a sequela of vascular insult to the pons. Although most patients with "locked-in" syndrome due to cerebrovascular disease die acutely, some survive, particularly if the pontine injury is due to brainstem encephalitis [5]. An infectious or postinfectious etiology was considered here.…”