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Favorable outcome from a locked-in state despite extensive pontine infarction by MRI
Journal article   Peer reviewed

Favorable outcome from a locked-in state despite extensive pontine infarction by MRI

Edgar A Samaniego, Maarten G Lansberg, Michael DeGeorgia, Chitra Venkatasubramanian and Christine AC Wijman
Neurocritical care, Vol.11(3), pp.369-371
12/2009
DOI: 10.1007/s12028-009-9268-y
PMCID: PMC2921010
PMID: 19707888
url
https://www.ncbi.nlm.nih.gov/pmc/articles/2921010View
Open Access

Abstract

Introduction 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. Conclusion Patients who are in a locked-in state may have substantial functional recovery despite DWI evidence of extensive pontine infarction.
 Stroke infarction locked-in Cerebrovascular disease DWI

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