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Hi Everyone! Imagine you have a stroke or meet with an accident the next thing you know you wake up in a hospital bed you hear your loved ones crying and you can hear them talk you want to talk to them and tell them you are alright alas try as you may you are unable to talk or make any movement that can grab their attention you are locked in, Locked-in syndrome also known as pseudo-coma is a condition where the patient is conscious and able to think but unable to move or communicate verbally this means that these individuals cannot consciously or voluntarily chew, swallow, breathe or speak. However, they can move their eyes up and down as well as blink allowing them to communicate non-verbally as a result affected individuals are bedridden and have to rely completely on their caregiver.
A special feature of this syndrome
is that despite the physical paralysis the cognitive function of the patient is
preserved along with normal sleep-wake cycles, so how can one get the locked-in
syndrome damage to a specific part of the brainstem specifically the pons results
in locked-in syndrome. The pons is the middle part of the brainstem that connects
the cerebral cortex to the spinal cord when the motor cortex of the cerebrum initiates
movements, the signals travel through the brain stem and spinal cord before
they reach the muscles the pathway between the brain and the spinal cord is
called the corticospinal tract.
There are two such tracts in the pons each from either side of the brain when these cortico-spinal tracts have been damaged the bridge between the brain and the muscles are lost and the patient becomes quadriplegic not only is the pons an important motor relay center but it is also an important sensory relay center the sensations such as pain touch temperature and proprioception can be either diminished or completely lost when it's damaged consciousness and cognitive function are preserved since the upper brain areas are not affected.
Pons is supplied by the artery
called the basilar artery an ischemic or hemorrhagic stroke of this basilar
artery can lead to tissue death or infarction in the Pons and result in
locked-in syndrome additional causes of the locked-in syndrome are heroin abuse abscesses
or tumors in the ponds toxins and others diagnosing locked-in syndrome is very difficult
as most patients will be in a coma for a while before they develop the
locked-in syndrome the diagnosis can easily be missed if eye movement is not
assessed 50% of the time it is a loved one that notices the eye movements while
talking to the patient appearing to be in a coma.
Diagnosis can be confirmed from several tests which include MRI and EEG. An MRI will show damage in the pons and will help us rule out damage anywhere else in the brain, while the EEG will reveal normal brain activity and sleep-wake cycles in those with the locked-in syndrome at present there is no specific treatment or cure available for the locked-in syndrome as these individuals are not able to even breathe without support it is very important to provide supportive treatment for breathing and feeding especially early on currently the mainstay of treatment is physiotherapy, comfort care, nutritional support and prevention of systematic complications such as respiratory infections most people with the locked-in syndrome do not live beyond the early stage of the disease while some live for 10 to 20 more years. Although it is extremely rare to regain any significant motor function it isn't impossible either for you.
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