title: Transient total mesencephalic locked-in syndrome after bilateral ptosis due to basilar artery thrombosis.
abstract: Locked-in syndrome (LIS) usually occurs as a result of pontine lesions and has been classified into various categories on the basis of neurologic conditions, of which transient total mesencephalic LIS is extremely rare. A 53-year-old man presented with bilateral ptosis followed by a total locked-in state. In the clinical course, the patient successfully recovered with only left slight hemiparesis and skew deviation remaining. Magnetic resonance imaging revealed multiple ischemic lesions caused by thrombosis at the top of basilar artery, including the bilateral cerebral peduncles, tegmentum of the midbrain, and the right cerebellar hemisphere. Antecedent bilateral ptosis before the locked-in state may be related to ischemia in the central caudal nucleus of the oculomotor nuclei. We should pay attention to this easily missed condition during the treatment of ischemic stroke involving the basilar artery.
authors.affiliation: Department of Neurosurgery, Osaka Neurological Institute, Osaka, Japan. yasufujimoto@gmail.com
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Fujimoto
authors.forename: Yu-ichiro
authors.initials: Y
authors.lastname: Ohnishi
authors.forename: Akatsuki
authors.initials: A
authors.lastname: Wakayama
authors.forename: Toshiki
authors.initials: T
authors.lastname: Yoshimine
mesh_terms: D001763:Blepharoptosis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D038524:Diffusion Magnetic Resonance Imaging; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008636:Mesencephalon / Q000098:blood supply* / Q000503:physiopathology; D008875:Middle Aged; D015835:Ocular Motility Disorders / Q000209:etiology; D010291:Paresis / Q000209:etiology; D011782:Quadriplegia / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D020127:Recovery of Function; D013927:Thrombosis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D014715:Vertebrobasilar Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy