Emergency Medicine Residency Program, McGill University Health Centre, Royal Victoria Hospital, Montreal, QC, Canada.
CJEM. 2012 Sep;14(5):317-20.
Locked-in syndrome (LIS) is the combination of quadriplegia and anarthria (inability to speak), with the preservation of consciousness. The majority of cases are caused by basilar artery occlusion leading to brainstem infarction in the ventral pons, yet numerous other etiologies have been described. The diagnosis of LIS is completely dependent on the physician's ability to know that these manifestations originate in the brainstem and the posterior circulation that supplies it. This knowledge hinges on the ability of the examining physician to conduct a rapid, yet appropriately thorough neurologic examination. With recent advances in interventional neuroradiology leading to improved patient outcomes, LIS has evolved into a critical, time-dependent diagnosis. Herein, we present the case of a male patient who initially presented to the emergency department of a community hospital with coma of unknown cause. By presenting this case and focusing on the importance of the occulomotor exam, we hope to help in the rapid identification and treatment of patients with LIS in the emergency room and avoid outcomes similar to that of our patient.
闭锁综合征（LIS）是四肢瘫痪和构音障碍（无法说话）的组合，意识保留。大多数病例是由基底动脉闭塞导致脑桥腹侧梗死引起的，但也有许多其他病因已被描述。LIS 的诊断完全取决于医生是否知道这些表现起源于脑干和供应它的后循环。这种知识取决于检查医生进行快速但适当全面的神经系统检查的能力。随着介入神经放射学的最新进展导致患者预后改善，LIS 已发展成为一种关键的、依赖时间的诊断。在此，我们介绍了一位男性患者的病例，他最初因不明原因的昏迷到社区医院的急诊科就诊。通过呈现这个病例并关注眼动检查的重要性，我们希望帮助在急诊室快速识别和治疗 LIS 患者，并避免出现与我们患者类似的结果。
