Recovery From the 'Locked-in' Syndrome

McCusker, Elizabeth; Rudick, Richard A.; Honch, Gerald W.; Griggs, Robert C.

doi:10.1001/archneur.1982.00510150015004

Cited by 63 publications

(22 citation statements)

References 23 publications

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“…12 Several authors have reported on the possibility of a good motor outcome in complete LIS. 19,20,22,23 Our series echoes this view with 4/11 patients recovering efficient motor control. At the onset, three of these four patients presented with total LIS, and were clinically indistinguishable from the seven patients in which motor control remained minimal.…”

Section: Diagnosis and Prognosis Of Lissupporting

confidence: 65%

“…9,6,26,27 In this hypothesis, the clinical features reported here, namely distal motor control, limited spasticity and axial hypotonia are rather surprising, albeit previously noted by other authors. 15,22,24,25 The view of LIS as bilateral pyramidal tract interruption is probably an oversimplification, and other structures may be involved. At the pontine level, the pyramidal tract is intermin � led with the grey matter of the cerebellar nuclei, 8 which probably suffers ischaemia before the myelinated fibres.…”

Section: Motor Control In Lismentioning

confidence: 99%

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

et al. 1995

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We report 11 patients with the locked in syndrome (LIS). The functional outcome was good in four patients with notable motor recovery, but motor deficit remained seriously disturbed in seven patients. All of the patients regained some distal control of finger and toe movements, often allowing functional use of a digital switch. The independence thereby gained is worthwhile, in some patients allowing environment control, communication by means of a computer, and electric wheelchair ambulation. When motor recovery occurs, the progression is disto-proximal with dramatic axial hypotonia. In five patients clinical insomnia was noted and polysomnography showed a reduction of REM sleep. The implications of systems other than the pyramidal tracts in the physiopathology of LIS are discussed.

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Section: Diagnosis and Prognosis Of Lissupporting

confidence: 65%

Section: Motor Control In Lismentioning

confidence: 99%

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

et al. 1995

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“…Although our patient with a complete medulla cervical spinal cord transection had nil likelihood of functional recovery, there have been reports of patients who present with LIS or similar dense neurologic deficit at the craniocervical level with preservation of structure that have surprising degrees of recovery. 49,50 It is commonly assumed that the quality of life of a patient with LIS is so poor that it is not worth living. However, the contrary is exposed in the work by Jean-Dominique Bauby, 'The Diving Bell and the Butterly: A Memoir of Life in Death'.…”

Section: Discussionmentioning

confidence: 99%

Complete medulla/cervical spinal cord transection after atlanto-occipital dislocation: An extraordinary case

2006

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Study design: Case report. Summary of background data: Traumatic atlanto-occipital dislocation (AOD) with a complete medulla/spinal cord transection is rare and believed to be fatal owing to the high level of the spinal cord injury. Clinical outcome is poor. Consequently, relatively few case reports of adult patients surviving this injury appear in the literature. Objectives and result: We present the case of a 20-year-old male, who sustained an AOD with a complete medulla/spinal cord transection in a motorcycle accident to discuss the possibility of long-term survival with this condition. The patient underwent occipito-cervical stabilization. With an Injury Severity Score of 75, by definition unsurvivable, the patient is 16 months after the injury, ventilated and fully dependent for all care. Conclusion: Long-term survival following AOD with a complete medulla/spinal cord transection is possible if immediate resuscitation at the scene is available. Nevertheless, it remains questionable whether or not a patient with such a devastating injury and without any prospect of functional recovery should be kept alive under all circumstances.

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“…18,21) Other possible causes are head trauma, 3,10) pontine hemorrhage, 12) infection, 13,15) central pontine myelinosis, 14) and multiple sclerosis. 8) Some cases of locked-in syndrome were caused by primary pontomedullary tumor.…”

Section: Discussionmentioning

confidence: 99%

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

İnci

Özgen

2003

Neurol. Med. Chir.(Tokyo)

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A 21-year-old man presented with an extremely rare case of locked-in syndrome caused by a metastatic brainstem tumor manifesting as quadriplegia, lower cranial nerve pareses, and irregular respiration. Cranial magnetic resonance imaging revealed a large pontomedullary tumor. An emergency operation was performed via a posterior fossa approach and the tumor was grossly totally removed. The histological diagnosis was malignant melanoma. The clinical status of the patient remained unchanged and he died on postoperative day 34 of diffuse bronchopneumonia. Locked-in syndrome is characterized by quadriplegia, lower cranial nerve paralysis, and mutism but with maintenance of consciousness, as well as vertical eye movements and eyelid blinking. This case suggests that locked-in syndrome should be considered in any patient seemingly comatose or stuporous, this syndrome may be due to a pontomedullary tumor, and malignant melanoma metastasis should be considered in the differential diagnosis of patients who present with brainstem tumor.

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Recovery From the 'Locked-in' Syndrome

Cited by 63 publications

References 23 publications

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

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

Complete medulla/cervical spinal cord transection after atlanto-occipital dislocation: An extraordinary case

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

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