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Locked-In Syndrome — SCE Neurology MCQ

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ModerateCerebrovascular DiseaseLocked-In SyndromeSCE Neurology

A 62-year-old man is brought to the emergency department after being found unresponsive. On examination he has no verbal output, no limb movements to command or pain, but he can open his eyes and blink to command. He tracks objects vertically. Horizontal eye movements are absent. MRI brain shows an acute ventral pontine infarct sparing the tegmentum. What is this syndrome?

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Correct answer: E — Locked-in syndrome

Locked-in syndrome results from a ventral pontine lesion (typically basilar artery occlusion) that destroys the corticospinal and corticobulbar tracts while sparing the reticular activating system (in the tegmentum) and vertical gaze pathways. Patients are fully conscious but can only communicate through vertical eye movements and blinking. It is essential to distinguish from disorders of consciousness. A: Vegetative state has no awareness. C: Brain death has no brainstem reflexes. D: Catatonia has psychiatric features. E: Akinetic mutism has reduced motivation.

Reference: RCP National Clinical Guideline for Stroke (2023); Plum & Posner Diagnosis of Stupor and Coma