title: Favorable outcome from a locked-in state despite extensive pontine infarction by MRI.
abstract: BACKGROUND
  Outcome prediction of patients who are in a locked-in state is challenging. Extensive pontine infarction on diffusion weighted imaging MRI (DWI) has been proposed as a poor prognosticator. We report on three patients with a locked-in state with unexpected favorable recoveries despite DWI evidence of widespread pontine ischemia.
  
  
  METHODS
  Report of three cases.
  
  
  RESULTS
  Three young patients (32-, 30-, and 16-years-old) presented with a locked-in state caused by pontine infarction. The first patient did not receive any acute stroke therapies, the second patient underwent endovascular therapy 20 h after symptom onset resulting in partial recanalization of the basilar artery, and the third patient progressed to a locked-in state despite having received intravenous tissue plasminogen activator. The DWI of all three patients demonstrated acute and widespread pontine infarction involving more than two-thirds of the pons. Two patients regained full independence in their activities of daily living. The third patient remained wheelchair bound, but lives with her family, eats independently, uses a typewriter and wrote a book.
  
  
  CONCLUSIONS
  Patients who are in a locked-in state may have substantial functional recovery despite DWI evidence of extensive pontine infarction.
authors.affiliation: Stanford Stroke Center, 701 Welch Road, Bldg B, Ste 325, Palo Alto, CA 94304-1702, USA. esamanie@stanford.edu
authors.forename: Edgar Andres
authors.initials: EA
authors.lastname: Samaniego
authors.forename: Maarten G
authors.initials: MG
authors.lastname: Lansberg
authors.forename: Michael
authors.initials: M
authors.lastname: DeGeorgia
authors.forename: Chitra
authors.initials: C
authors.lastname: Venkatasubramanian
authors.forename: Christine A C
authors.initials: CA
authors.lastname: Wijman
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D002544:Cerebral Infarction / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D008297:Male; D011149:Pons / Q000098:blood supply / Q000473:pathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D011782:Quadriplegia / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy; D020127:Recovery of Function; D016896:Treatment Outcome
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