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

Neurocrit Care. 2009 Dec;11(3):369-71. doi: 10.1007/s12028-009-9268-y.


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.

Publication types

  • Case Reports

MeSH terms

  • Activities of Daily Living
  • Adolescent
  • Adult
  • Cerebral Infarction / pathology*
  • Cerebral Infarction / physiopathology
  • Cerebral Infarction / therapy
  • Diffusion Magnetic Resonance Imaging*
  • Female
  • Humans
  • Male
  • Pons / blood supply
  • Pons / pathology*
  • Predictive Value of Tests
  • Prognosis
  • Quadriplegia / pathology*
  • Quadriplegia / physiopathology
  • Quadriplegia / therapy
  • Recovery of Function*
  • Treatment Outcome