[Locked-in syndrome in vascular pathology of the brain]

Abstract

Seven patients with vascular abnormalities of the brain (infarct of the ventral portions of the pons varolii and/or the midbrain--5, hemorrhage into the base of the pons varolii--1 and transient impairment of the cerebral circulation in the vertebro-basilar system--presented the locked-in syndrome with such underlying disorders as tetraplegia with the maintenance of tendon and the appearance of abnormal plantar muscle reflexes, pseudobulbar syndrome with intact consciousness and the absence of any significant changes in the EEG. Other findings included disorders of eye movement, mainly in the horizontal plane and involuntary muscular activity such as forced crying, decerebrational and decorticational muscular spasms, as well as masticatory automatisms. The authors emphasize the identity of the given syndrome and Filimonov's syndrome which was repeatedly described in Soviet literature before 1966 when the term "locked-in syndrome" was proposed. They also discuss the pathogenetic mechanisms of the development of the locked-in syndrome in occlusion of the basilar artery.