Abstract
BackgroundLocked-in syndrome, although a notoriously famous clinical entity, the rarity of the condition coupled with the variability of clinical features on acute presentation represents a potential diagnostic pitfall for the emergency physician.CaseA previously healthy 25-year-old female was brought to our Emergency Department after being found unresponsive. On examination, she was conscious and alert with a Glasgow Coma Score of 9; on neurological examination, the patient was quadriplegic and unable to speak but was able to move her eyes and blink. Non-contrast brain computed tomography (CT) revealed a hyperdense basilar artery, and CT cerebral angiography confirmed basilar artery thrombosis.ConclusionThis case highlights the need for a high index of suspicion to make a diagnosis of locked-in syndrome in the Emergency Department, especially in young patients with no apparent risk factors for an ischemic stroke. The hyperdense basilar artery sign is one of the earliest signs on non-contrast CT imaging and may be the only clue to guide further management in a patient with basilar artery occlusion.
Highlights
Locked-in syndrome, a notoriously famous clinical entity, the rarity of the condition coupled with the variability of clinical features on acute presentation represents a potential diagnostic pitfall for the emergency physician.Case: A previously healthy 25-year-old female was brought to our Emergency Department after being found unresponsive
This case highlights the need for a high index of suspicion to make a diagnosis of locked-in syndrome in the Emergency Department, especially in young patients with no apparent risk factors for an ischemic stroke
The patient was conscious and alert but appeared extremely distressed, continuously frothing at the mouth with trismus and tongue protrusion requiring regular suctioning; she was able to maintain her airway and all vital signs were within normal limits
Summary
This case highlights the need for a high index of suspicion to make a diagnosis of locked-in syndrome in the Emergency Department, especially in young patients with no apparent risk factors for an ischemic stroke. The hyperdense basilar artery sign is one of the earliest signs on non-contrast CT imaging and may be the only clue to guide further management in a patient with basilar artery occlusion. The patient was conscious and alert but appeared extremely distressed, continuously frothing at the mouth with trismus and tongue protrusion requiring regular suctioning; she was able to maintain her airway and all vital signs were within normal limits. Our patient was deemed not a candidate for thrombolysis and was managed conservatively due to several factors including a late presentation (over 10 h from last known normal) and remained locked-in at the time of her discharge from hospital
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