Citation

Horan J, Tromp S, Mankahla N. World Neurosurg. 2019; ePub(ePub): ePub.

Affiliation

Department of Neurosurgery, Groote Schuur Hospital and University of Cape Town, South Africa.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.wneu.2019.03.163

PMID

30922899

Abstract

BACKGROUND: Locked-in syndrome (LIS) is a rare neurological disorder characterised as quadriplegia with anarthria. The diagnosis of LIS is challenging and requires a high index of suspicion. The syndrome is typically due to an infratentorial lesion to the ventral pons, regardless of aetiology. LIS secondary to supratentorial injury is extremely rare and to our knowledge this is the first reported case. CASE DESCRIPTION: We report the case of a 26-year-old woman who sustained a gunshot to the left suboccipital area, with supratentorial extension. A diagnosis of incomplete LIS was made on day of admission, with eye movement preservation. Imaging studies confirmed bilateral injury of the motor homunculus. The clinical course was that of progressive improvement, aided by ICU supportive care and early physiotherapy rehabilitation. Her condition improved and she was discharged to a rehabilitation facility at the end of week 7 post admission.

CONCLUSION: This is a unique case of incomplete LIS following supratentorial injury. Initial ICU care and early rehabilitation likely played a major role in the full recovery of this patient. The influence of aetiology and site of injury on outcome prognosis is also suggested. Although severe diffuse brain injury may occur in the face of an unremarkable CT scan, the emerging role of MRI in optimally evaluating traumatic brain injury with discordant clinical and CT information is highlighted and is useful in cases of LIS where prognosis prediction is important.

Copyright © 2019 Elsevier Inc. All rights reserved.

Language: en

Keywords

cerebral gunshot injury; locked in syndrome; neurotrauma