尽管磁共振成像显示广泛的脑桥梗死，患者仍处于闭锁状态且预后良好。
Favorable outcome from a locked-in state despite extensive pontine infarction by MRI.
机构信息
Stanford Stroke Center, 701 Welch Road, Bldg B, Ste 325, Palo Alto, CA 94304-1702, USA.
出版信息
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.
简介
处于闭锁状态的患者的预后预测具有挑战性。弥散加权成像 MRI（DWI）上广泛的脑桥梗死被认为是预后不良的指标。我们报告了三例闭锁状态患者，尽管 DWI 显示广泛的脑桥缺血，但他们的预后却出人意料地良好。
方法
报告三例病例。
结果
三名年轻患者（32 岁、30 岁和 16 岁）因脑桥梗死而出现闭锁状态。第一位患者未接受任何急性卒中治疗，第二位患者在症状发作后 20 小时接受了血管内治疗，导致基底动脉部分再通，第三位患者尽管接受了静脉组织型纤溶酶原激活剂治疗，但仍进展为闭锁状态。这三例患者的 DWI 均显示急性和广泛的脑桥梗死，累及脑桥的三分之二以上。两名患者恢复了日常生活的完全独立性。第三位患者仍需坐轮椅，但与家人同住，能够独立进食，使用打字机并著书。
结论
尽管 DWI 显示广泛的脑桥梗死，但闭锁状态的患者可能会有显著的功能恢复。
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