Favorable outcome from a locked-in state despite extensive pontine infarction by MRI.
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.
Samaniego
Edgar Andres
EA
Stanford Stroke Center, 701 Welch Road, Bldg B, Ste 325, Palo Alto, CA 94304-1702, USA. esamanie@stanford.edu
Lansberg
Maarten G
MG
DeGeorgia
Michael
M
Venkatasubramanian
Chitra
C
Wijman
Christine A C
CA
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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