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Locked-in syndrome — SCE Neurology MCQ

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ModerateStrokeLocked-in syndromeSCE Neurology

A 55-year-old man presented with quadriplegia and anarthria after sudden collapse but preserved awareness. On examination, vertical eye movements and blinking were preserved. Initial investigations showed: MRI showed bilateral ventral pontine infarction. Where is the most likely anatomical localisation?

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Correct answer: C — bilateral ventral pons

bilateral ventral pons is the best answer because the vignette describes Locked-in syndrome: preserved consciousness with quadriplegia and vertical eye movement localises to ventral pons. Thoracic spinal cord is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Ventral pons and Frontal-subcortical circuits are less appropriate because they would require different localisation, timing or test findings; Basal ganglia nigrostriatal pathway would fit a different syndrome. Clinical pearl: coma would imply impaired arousal rather than preserved awareness.

Reference: NICE NG128; National Clinical Guideline for Stroke; DVLA Assessing fitness to drive