Premonitory symptoms of stroke in evolution to the locked-in state.

Abstract

Three patients, who subsequently developed the locked-in state characterized by quadriplegia and mutism with an alert sensorium, initially had mild dysarthria and uncrossed hemisensory or hemimotor deficits involving the face and ipsilateral extremities. Case 1 initially mimicked a left cerebral lesion with right hemisensory deficits, a mild right facial paresis and a right homonymous field deficit. Case 2 initially developed both left hemimotor and hemisensory deficits and later developed a paresis of right conjugate gaze. Case 3 presented with left hemimotor deficit, and mild paresis of conjugate gaze to the right. All 3 patients died. Rostral brainstem infarctions were found at necropsy in cases 1 and 3. Case 3 had a radiolucent area of the brainstem demonstrated by CT [computer tomography] Scan. Hemisensory and hemimotor deficits also were noted to precede reported cases of pontine infarction with the locked-in state. Acute onset of uncrossed hemisensory and hemimotor deficits with dysarthria may be caused by infarction of the pons which may predispose to the locked-in state.