Two different manifestations of locked-in syndrome.

[locked-in syndrome]

Locked-in syndrome (LIS ) is an entity that usually occur a consequence of the lesion of ventral part of pons . Etiology of locked-in syndrome can be vascular and nonvascular origin . Locked-in syndrome usually occurs as a consequence of thrombosis of intermedial segment of basilar artery that induces bilateral infarction of the ventrobasal part of the pons . Additionally , LIS can be caused by trauma which often leads to posttraumatic thrombosis of basilar artery . The incidence of locked-in syndrome is still unknown . The basic clinical features of locked-in syndrome are : quadriplegia (a consequence of disruption of corticospinal pathways located in ventral part of pons ), different stages of paralysis of mimic musculature , paralysis of pharynx , tongue and palate with mutism and anarthria . The patient can not move , but is conscious and can communicate only by eye movements . Two patients with locked-in syndrome were present in this article . In the first case , the patient had classic locked-in syndrome that was first described by Plum and Posner . Other patient had incomplete form of locket-in syndrome which was first described by Bauer . In these two patients locked-in syndrome occurred as a consequence of trauma . In the first patient locked-in syndrome was caused by direct contusion of ventral part of pons while in other patient locked-in syndrome was a consequence of posttraumatic thrombosis of vertebrobasilar artery . The introduction of anticoagulant therapy , besides the other measures of intensive therapy , has shown complete justification in the second patient . The gradual partial recovery of neurologic deficit has developed in the second patient without any additional complications .