title: Yawning despite trismus in a patient with locked-in syndrome caused by a thrombosed megadolichobasilar artery.
abstract: We report a 62-year-old woman with a locked-in syndrome with bilateral masticatory spasms and persistent trismus, who was still able to yawn. A vascular malformation of the basilar artery-megadolichobasilar artery (fusiform aneurysm, vertebrobasilar dolichoectasia) was determined to be the underlying cause of this rare combination of symptoms. A thrombus in the megadolichobasilaris as well as an almost total pontine infarction were demonstrated on CT- and MRI-scans. Thus, trismus may be associated with locked-in syndrome due to megadolichobasilar artery thrombus, although yawning is still possible.
authors.affiliation: Department of Neurology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, D-06097 Halle (Saale), Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Krasnianski
authors.forename: Charly
authors.initials: C
authors.lastname: Gaul
authors.forename: Stephan
authors.initials: S
authors.lastname: Neudecker
authors.forename: Curd
authors.initials: C
authors.lastname: Behrmann
authors.forename: Andreas
authors.initials: A
authors.lastname: Schlüter
authors.forename: Martin
authors.initials: M
authors.lastname: Winterholler
mesh_terms: D001933:Brain Stem / Q000503:physiopathology; D020526:Brain Stem Infarctions / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D004108:Dilatation, Pathologic / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D004292:Dominance, Cerebral / Q000502:physiology; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D020766:Intracranial Embolism / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009415:Nerve Net / Q000503:physiopathology; D009460:Neurologic Examination; D011149:Pons / Q000098:blood supply*; D011782:Quadriplegia / Q000209:etiology / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed; D014313:Trismus / Q000503:physiopathology*; D015000:Yawning / Q000502:physiology*