Locked-in Syndrome

Abstract

Objective ‒ to sharpen the attention of doctors to a rare, little-known pathology of damage to the ventral parts of the pons, the upper parts of the medulla oblongata ‒ the locked-in syndrome. The extremely important value of this syndrome can be in determining the prognosis of the disease and solving issues of rehabilitation and patient care. Locked-in syndrome is a rare, complex clinical and neurological symptom complex, the basis of which is a lesion of the front parts of the pons with intact functioning of the nuclei and afferents of the brain stem cover. The locked-in syndrome occurs when blood circulation is disturbed in the ventral parts of the brain stem and pons. According to the criteria of the American Congress of Rehabilitation Medicine, the locked-in syndrome is a combination of: 1) stable opening of the eyes; 2) safety of basic cognitive abilities; 3) aphonia or severe hypophonia; 4) tetraplegia or tetraparesis; 5) the main method of communication, used by the patient – movement of the eyes in a vertical or horizontal plane or blinking of the upper eyelid. The definition of this syndrome and the localization of its injuries, which cause it, became possible when long-term lung ventilation and neuroimaging methods ‒ spiral computer tomography and magnetic resonance imaging ‒ were introduced into clinical practice. Three personal observations of the occurrence of the locked-in syndrome of different etiology are given: with ischemic damage to the ventral parts of the pons of the brain, with hemorrhage in the ventral parts of the pons, with traumatic damage to the ventral parts of the brain stem. The dynamics of neurological disorders, their adequate assessment during neuroimaging allow timely diagnosis of the localization of the process and the prognosis of the disease, and therefore the choice of methods of treatment, rehabilitation or long-term care for the patient.

Keywords

• pons; ventral parts; oculomotor nerves; circulatory disorders; locked-in syndrome.