A misdiagnosed patient: 16 years of locked-in syndrome, the influence of rehabilitation.

BACKGROUND

LiS can be mistakenly recognized as a vegetative state, minimally conscious state or akinetic mutism. It can be caused by isolated lesions--bilateral infarction, vertebrobasilar artery osslusion, haemorrhage or tumor of the ventral portion of the basis pontis or midbrain.

CASE REPORT

The case of a 65-year-old patient with a brain tumor localized in the posterior part of the posterior commissure of the brain was presented. He lost consciousness in 1991, was diagnosed as being at a terminal stage and from 2005 he started to improve. In MRI brain tumor stated in 1989 with the same localization and size in 2007 without any disturbance in cerebral fluid flow. The patients remained in this condition for 14 years without any rehabilitation, because he was diagnosed as a terminal stage, a non-operative stage. When exercises were introduced in 2005 the patient started to recover. In 2007 he was conscious with quadriplegia, a neuropsychological test showed memory problems, without any dementia. After intensive rehabilitation functional improvement and speech improvement was observed, GOS (4), Ranczo Los Amigos Scale (6), DRS (18).

CONCLUSIONS

It is important to carry out full diagnostics before determining a terminal stage and to continue a rehabilitation program and multisensory stimulation. Even after 16 year of lying in bed without communication there is a chance in LiS to witness improvement after stimulation, without any signs of dementia.