locked-in syndrome; cognitive-motor dissociation
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Etiology
- lesions involving the ventral pons bilaterally
- basilar artery thrombosis or embolism
- traumatic brain injury[3]
Clinical manifestations
- quadriplegia
- loss of lower cranial nerve function
- wakefulness & awareness of the environment
- vertical eye movements & blinking are often preserved
- may be only mechanism for patient to communicate with the outside world
- preserved tendon reflexes
- Babinski's sign
- abnormal pupillary reflexes
Laboratory
- electroencephalography (EEG) is often normal
Radiology
- 25% of patients with traumatic brain injury show MRI &/or EEG evidence of cognitive-motor dissociation[3]
Differential diagnosis
More general terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1074
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
- ↑ 3.0 3.1 3.2 George J One in Four Brain Injury Patients Who Appear Unresponsive Respond Covertly. Functional MRI and EEG detect awareness in coma or vegetative states. MedPage Today, August 14, 2024 https://www.medpagetoday.com/neurology/generalneurology/111520
Bodien TG et al Cognitive Motor Dissociation in Disorders of Consciousness. Engl J Med. 2024. Aug 14. PMID: https://www.ncbi.nlm.nih.gov/pubmed/39141852 https://www.nejm.org/doi/full/10.1056/NEJMoa2400645