Transient locked-in syndrome and basilar artery vasospasm

Abstract

Background: Cerebral vasospasm is the main cause of neurological mortality and morbidity following subarachnoid hemorrhage. Basilar artery vasospasm (BAVS) is associated with a high morbidity and may have multiple clinical presentations.

Methods: We report the case of a 43 years-old man with BAVS presenting as a reversible locked-in syndrome (LIS) after stopping sedation.

Results: The symptoms were successfully managed by intra-arterial infusion of vasodilators and balloon angioplasty. Magnetic resonance imaging did not reveal any brainstem lesion 48 h after the complication, demonstrating a hemodynamic mechanism.

Conclusion: LIS can reveal BAVS. Its diagnosis relies on clinical examination. In this case, rapid neuro-interventional treatment permitted reversal of symptoms. This could not have been possible under sedation.