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Locked-in syndrome as an unusual complication of acute otitis media.
[locked-in syndrome]
A
32
-
year
-old
woman
developed
altered
consciousness
two
days
after
initial
symptoms
of
acute
otitis
media
,
with
purulent
discharge
from
the
right
ear
.
She
was
quadriplegic
,
with
spontaneous
eye
opening
,
mild
neck
stiffness
,
and
lacking
vestibular
-
ocular
reflexes
.
Upon
admission
,
the
patient
was
subjected
to
brain
computed
tomography
(
CT
)
,
magnetic
resonance
imaging
(
MRI
)
,
and
lumbar
puncture
.
CT
was
consistent
with
pansinusitis
,
right
middle
ear
otitis
,
mastoiditis
,
and
sphenoiditis
.
No
brainstem
lesion
was
evident
;
brain
MRI
demonstrated
ischemic
and
secondary
hemorrhagic
lesions
in
the
pons
and
cerebral
peduncles
.
The
dura
mater
in
the
petroclival
space
was
intensely
inflamed
,
and
likely
responsible
for
reduced
basilar
arterial
blood
flow
.
Lumbar
puncture
yielded
clear
cerebrospinal
fluid
;
gram
stain
examination
was
negative
and
culture
remained
sterile
.
Streptococcus
pneumoniae
and
Haemophilus
influenzae
were
cultured
from
the
purulent
ear
discharge
.
The
final
diagnosis
was
locked-
in
syndrome
consecutive
to
inflammatory
changes
compressing
the
basilar
artery
.
Diseases
Validation
Diseases presenting
"blood flow"
symptom
alexander disease
cadasil
congenital diaphragmatic hernia
heparin-induced thrombocytopenia
hydrocephalus with stenosis of the aqueduct of sylvius
inclusion body myositis
locked-in syndrome
lymphangioleiomyomatosis
oral submucous fibrosis
sneddon syndrome
typhoid
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