Locked-in syndrome usually results in quadriparesis and the
inability to speak in otherwise cognitively intact individuals.
Patients with locked-in syndrome may be able to communicate
with others through coded messages by blinking or moving their
eyes, which are often not affected by the paralysis. Patients with
locked-in syndrome are conscious and aware with no loss of
cognitive functions. They sometimes can retain proprioception
and sensation throughout their body. Some patients with lockedin
syndrome may have the ability to move some muscles of the
face, and some or all of the extraocular eye muscles. Patients
with locked-in syndrome lack coordination between breathing
and voice that restricts them from producing voluntary sounds,
even though the vocal cords themselves are not paralyzed. In
children, the commonest cause is a stroke of the ventral pons.
Unlike persistent vegetative state, locked-in syndrome is caused
by damage of the lower brain and brainstem without damage to
How to Approach an Unconscious Patient | 31
the upper brain (Leon Carrion 2002). Possible causes of locked-in
syndrome include: traumatic brain injury, diseases of the
circulatory system, overdose of certain drugs, various causes
which lead to damage to the nerve cells, particularly destruction
of the myelin sheath, e.g., central pontine myelinolysis
secondary to rapid correction of hyponatremia and basilar
artery (ischemic or hemorrhagic) stroke.
There is neither a standard treatment for locked-in syndrome,
nor is there a cure, but stimulation of muscle reflexes with
electrodes (NMES) has been known to help patients regain some
muscle function. Assistive computer interface technologies in
combination with eye tracking may be used to help patients
communicate. Direct brain stimulation research developed a
technique that allows locked-in patients to communicate via
sniffing (Leon Carrion 2002). It is extremely rare for any
significant motor function to return and the majority of lockedin
syndrome patients do not regain motor control, but devices
are available to help patients communicate. 90% die within the
first four months after onset. However, some patients continue
to live for much longer periods of time (Bateman 2001).
inability to speak in otherwise cognitively intact individuals.
Patients with locked-in syndrome may be able to communicate
with others through coded messages by blinking or moving their
eyes, which are often not affected by the paralysis. Patients with
locked-in syndrome are conscious and aware with no loss of
cognitive functions. They sometimes can retain proprioception
and sensation throughout their body. Some patients with lockedin
syndrome may have the ability to move some muscles of the
face, and some or all of the extraocular eye muscles. Patients
with locked-in syndrome lack coordination between breathing
and voice that restricts them from producing voluntary sounds,
even though the vocal cords themselves are not paralyzed. In
children, the commonest cause is a stroke of the ventral pons.
Unlike persistent vegetative state, locked-in syndrome is caused
by damage of the lower brain and brainstem without damage to
How to Approach an Unconscious Patient | 31
the upper brain (Leon Carrion 2002). Possible causes of locked-in
syndrome include: traumatic brain injury, diseases of the
circulatory system, overdose of certain drugs, various causes
which lead to damage to the nerve cells, particularly destruction
of the myelin sheath, e.g., central pontine myelinolysis
secondary to rapid correction of hyponatremia and basilar
artery (ischemic or hemorrhagic) stroke.
There is neither a standard treatment for locked-in syndrome,
nor is there a cure, but stimulation of muscle reflexes with
electrodes (NMES) has been known to help patients regain some
muscle function. Assistive computer interface technologies in
combination with eye tracking may be used to help patients
communicate. Direct brain stimulation research developed a
technique that allows locked-in patients to communicate via
sniffing (Leon Carrion 2002). It is extremely rare for any
significant motor function to return and the majority of lockedin
syndrome patients do not regain motor control, but devices
are available to help patients communicate. 90% die within the
first four months after onset. However, some patients continue
to live for much longer periods of time (Bateman 2001).
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