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Locked-in syndrome: a critical and time-dependent diagnosis

Published online by Cambridge University Press:  11 May 2015

David Barbic ,
Zachary Levine ,
Donatella Tampieri  and
Jeanne Teitelbaum
David Barbic*
Affiliation:
Emergency Medicine Residency Program, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC
Zachary Levine
Affiliation:
Department of Emergency Medicine, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC
Donatella Tampieri
Affiliation:
Department of Interventional and Diagnostic Radiology, Montreal Neurological Institute and Hospital, McGill University Health Centre, Montreal, QC
Jeanne Teitelbaum
Affiliation:
Intensive Care Unit, Montreal Neurological Institute and Hospital, McGill University Health Centre, Montreal, QC
*
Emergency Medicine Residency Program, McGill University Health Centre, Royal Victoria Hospital, 687 Pine Avenue West, Montreal, QC H3A 1A1; david.barbic@mail.mcgill.ca.

Abstract

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Locked-in syndrome (LIS) is the combination of quadriplegia and anarthria (inability to speak), with the preservation of consciousness. The majority of cases are caused by basilar artery occlusion leading to brainstem infarction in the ventral pons, yet numerous other etiologies have been described. The diagnosis of LIS is completely dependent on the physician's ability to know that these manifestations originate in the brainstem and the posterior circulation that supplies it. This knowledge hinges on the ability of the examining physician to conduct a rapid, yet appropriately thorough neurologic examination. With recent advances in interventional neuroradiology leading to improved patient outcomes, LIS has evolved into a critical, time-dependent diagnosis. Herein, we present the case of a male patient who initially presented to the emergency department of a community hospital with coma of unknown cause. By presenting this case and focusing on the importance of the occulomotor exam, we hope to help in the rapid identification and treatment of patients with LIS in the emergency room and avoid outcomes similar to that of our patient.

Keywords

basilar arterycritical illnessemergency medicinelocked-in syndromethrombosis
Type
Case Report • Rapport de cas
Information
Canadian Journal of Emergency Medicine , Volume 14 , Issue 5 , September 2012 , pp. 317 - 320
Copyright
Copyright © Canadian Association of Emergency Physicians 2012

References

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