INTRODUCTION: Outcome prediction of patients who are in a locked-in state is challenging. Extensive pontine infarction on diffusion weighted imaging MRI (DWI) has been proposed as a poor prognosticator. We report on three patients with a locked-in state with unexpected favorable recoveries despite DWI evidence of widespread pontine ischemia. METHODS: Report of three cases. RESULTS: Three young patients (32-, 30-, and 16-years-old) presented with a locked-in state caused by pontine infarction. The first patient did not receive any acute stroke therapies, the second patient underwent endovascular therapy 20 h after symptom onset resulting in partial recanalization of the basilar artery, and the third patient progressed to a locked-in state despite having received intravenous tissue plasminogen activator. The DWI of all three patients demonstrated acute and widespread pontine infarction involving more than two-thirds of the pons. Two patients regained full independence in their activities of daily living. The third patient remained wheelchair bound, but lives with her family, eats independently, uses a typewriter and wrote a book. CONCLUSION: Patients who are in a locked-in state may have substantial functional recovery despite DWI evidence of extensive pontine infarction.
INTRODUCTION: Outcome prediction of patients who are in a locked-in state is challenging. Extensive pontine infarction on diffusion weighted imaging MRI (DWI) has been proposed as a poor prognosticator. We report on three patients with a locked-in state with unexpected favorable recoveries despite DWI evidence of widespread pontine ischemia. METHODS: Report of three cases. RESULTS: Three young patients (32-, 30-, and 16-years-old) presented with a locked-in state caused by pontine infarction. The first patient did not receive any acute stroke therapies, the second patient underwent endovascular therapy 20 h after symptom onset resulting in partial recanalization of the basilar artery, and the third patient progressed to a locked-in state despite having received intravenous tissue plasminogen activator. The DWI of all three patients demonstrated acute and widespread pontine infarction involving more than two-thirds of the pons. Two patients regained full independence in their activities of daily living. The third patient remained wheelchair bound, but lives with her family, eats independently, uses a typewriter and wrote a book. CONCLUSION:Patients who are in a locked-in state may have substantial functional recovery despite DWI evidence of extensive pontine infarction.
Authors: T-H Cho; N Nighoghossian; F Tahon; C Némoz; M Hermier; F Salkine; L Derex; P Trouillas; J-C Froment; F Turjman Journal: AJNR Am J Neuroradiol Date: 2008-09-03 Impact factor: 3.825
Authors: C S Kidwell; J L Saver; J Mattiello; S Starkman; F Vinuela; G Duckwiler; Y P Gobin; R Jahan; P Vespa; M Kalafut; J R Alger Journal: Ann Neurol Date: 2000-04 Impact factor: 10.422
Authors: Richard du Mesnil de Rochemont; Tobias Neumann-Haefelin; Joachim Berkefeld; Matthias Sitzer; Heinrich Lanfermann Journal: Arch Neurol Date: 2002-03