The following are the characteristic signs and symptoms of LiS:
- Inability to control movements of the lower face
- Inability to chew, swallow and speak
- Difficulty in breathing
- Lower limbs become immobile
- Lateral movement of eye is not possible 
- Individuals can only blink eyes a number of times and vertically move their eyes.
- Hearing ability is intact and patients respond by blinking their eyes.
Entire Body System
He also uses it locally and nationally to advocate for the rights of people with disabilities beyond the Americans with Disabilities Act. [tirr.memorialhermann.org]
Explore Thesaurus Synonyms and related words Disability and people with disabilities ableism ableist accessible ... Explore Thesaurus Definition and synonyms of locked-in syndrome from the online English dictionary from Macmillan Education. [macmillandictionary.com]
This case report shows that specific rehabilitative approaches can be devised in severely disabled LIS patients with additional brain lesions and specific cognitive defects. [ncbi.nlm.nih.gov]
Hosted by National Disability Services WA, the Disability Support Awards were conceived in 2009 with the aim of building the reputation of the disability sector and showcasing it as a place for a rewarding career. [thewest.com.au]
A man developed locked-in syndrome after delayed surgery following a fall from a bicycle, an inquest has heard. [irishtimes.com]
This case highlights the unique dilemma when a patient falls between these two populations-conscious and cognitively intact, but completely paralyzed except for limited eye movement, afflicted by what the medical community refers to as locked-in syndrome [ncbi.nlm.nih.gov]
The former English teacher from Spalding, Lincolnshire, moved there a decade ago after falling in love on a dating website. [dailymail.co.uk]
Clodagh describes the feeling of falling from a Cesna airplane and hurltingtowards earth: "It blew me away just how beautiful the green chequered fields were. I don’t think I fully appreciated how beautiful our country was until I had a stroke." [rte.ie]
I had noted Harmon's tendency for micro-management when I went to visit him in the fall of 2010. [vice.com]
The following are additional conditions that may result in locked-in syndrome: Infection of certain portions of the brain Tumors Loss of myelin surrounding nerve cells (the protected insulation) Inflammation of the nerves (polymyositis) Amyotrophic lateral [belmarrahealth.com]
Local hormones, inflammation, and immune reactions 16. Anti-inflammatory and immunosuppressant drugs III. DRUGS AFFECTING MAJOR ORGAN SYSTEMS 17. The heart 18. The vascular system 19. Atherosclerosis and lipoprotein metabolism 20. [worldcat.org]
Additional conditions that can cause locked-in syndrome include infection in certain portions of the brain, tumours, loss of the protective insulation (myelin) that surrounds nerve cells (myelinolysis), inflammation of the nerves (polymyositis), and certain [brainfoundation.org.au]
Locked-in syndrome is typically caused by: Blood clot Stroke Infection Tumor Traumatic brain injury Medication or drug overdose or misuse Exposure to toxins Inflammation of the nerves Certain disorders including amyotrophic lateral sclerosis (ALS) Locked-in [medicalmalpracticehelp.com]
Other factors that can cause locked-in syndrome include: An infection of certain parts of the brain Damage to the protective layer of the nerve cells in your brain (called myelin) Tumors Nerve inflammation Other conditions, such as amyotrophic lateral [webmd.com]
- Arm Pain
This may cause a variety of symptoms including diffuse arm pain, headaches, pins and needles or numbness in the hands and upper back and neck pain or stiffness. [physioadvisor.com.au]
People usually die because of some breath insuficience or pneumonia. Links[✎ edit | edit source] Related articles[✎ edit | edit source] Apallic syndrome Brainstem Myelin sheath Pneumonia External links[✎ edit | edit source] NINDS Study case [wikilectures.eu]
Outcome :While admitted, patient developed ventilatory acquired pneumonia as caused of demise of patient. [iomcworld.org]
Streptococcus pneumoniae and Haemophilus influenzae were cultured from the purulent ear discharge. The final diagnosis was locked-in syndrome consecutive to inflammatory changes compressing the basilar artery. [ncbi.nlm.nih.gov]
Supportive care Communication training Supportive care is the mainstay of treatment for patients with locked-in syndrome and should include the following: Preventing systemic complications due to immobilization (eg, pneumonia, urinary tract infection, [msdmanuals.com]
He subsequently refused food and died of pneumonia six days later. The key difference between locked-in syndrome and the vegetative or minimally conscious state is that someone with locked-in syndrome is mentally intact, as Derick Wade explains. [healthtalk.org]
- Shoulder Pain
Chest radiography was done to investigate left shoulder pain and a lung lesion was found. No evidence of vascular or neurological disease was found before surgery. She was a non‐smoker and took no medication. [bja.oxfordjournals.org]
Don’t hold the phone between your shoulder and ear. Practice good posture to reduce neck and facial pain. Keep your teeth slightly apart as often as you can. This will relieve pressure on your jaw. [webmd.com]
Unfortunately, as I read this book, I found myself distracted from the inspiring story by the horrible grammar and syntax. [amazon.com]
The distracter receives 75% of the stimuli, while the left and right wrist each receives 12.5% of the stimuli. [frontiersin.org]
The company has “concocted a series of video games that reward high-attention states and discourage more distracted ones,” Johnson writes. [web.archive.org]
Patient W received no open questions because of low classification accuracy, which we and the parents attributed to her emotional state distracting her from concentrating on the responses because of the short time period of adaptation to the CLIS. [journals.plos.org]
You can feel pain, hunger, loneliness, and fear, but you can't react to those sensations. You are totally aware of your surroundings, but you can't communicate your feelings or desires, or even your basic needs. [mentalfloss.com]
By the time the press was informed in October 1998, Ray was able to move the cursor across a screen with icons representing messages — allowing him to indicate hunger or thirst, and to pick from among messages like “See you later.” [web.archive.org]
Causes of a Basilar Artery Stroke There are generally two types of strokes: (1) an ischemic stroke (where blood flow is restricted because of blockage) and (2) a hemorrhagic stroke (where blood vessels burst and there is too much blood in the brain). [thestrokelawyers.com]
References Related articles: Stroke and intracranial haemorrhage Promoted articles (advertising) [radiopaedia.org]
Whether sildenafil citrate may be helpful for recovery in human stroke is unknown at this time. [ncbi.nlm.nih.gov]
In children, the most common cause is a stroke of the ventral pons. [chroniclelive.co.uk]
Disease, a trauma or from a stroke. [dailymail.co.uk]
A 21-year-old man presented with an extremely rare case of locked-in syndrome caused by a metastatic brainstem tumor manifesting as quadriplegia, lower cranial nerve pareses, and irregular respiration. [ncbi.nlm.nih.gov]
This case suggests that locked-in syndrome should be considered in any patient seemingly comatose or stuporous, this syndrome may be due to a pontomedullary tumor, and malignant melanoma metastasis should be considered in the differential diagnosis of [ncbi.nlm.nih.gov]
Locked-in syndrome resembles stupor or coma because people have no obvious way of responding even though they are fully conscious. However, most can move their eyes up and down and blink. [msdmanuals.com]
In stupor, the patient demonstrates behavioural unresponsiveness and deep sleep. [ecronicon.com]
An older way of describing consciousness was to use terms like "clouded consciousness, obtundation, stupor" and "coma," each signifying a progressively more severe state. [stroke.about.com]
Prognostically important EEG coma patterns in diffuse anoxic and traumatic encephalopathies in adults. J Clin Neurophysiol 1988 ; 5: 161 – 174. Google Scholar | Medline 8. Austin, EJ, Wilkus, RJ, Longstreth, WT. Etiology and prognosis of alpha coma. [journals.sagepub.com]
Diffuse, focal, unilateral or anterior predominant high voltage delta activity is seen most frequently in metabolic encephalopathy. In others, low voltage delta coma may be seen. Spindle coma may be seen with traumatic brain injury. [ecronicon.com]
They can also be seen with various progressive encephalopathies that end in coma, such as Creutzfeldt-Jakob disease ( 11, 12 ). [tidsskriftet.no]
Common neurologic complications include the following: Toxic or metabolic encephalopathy - 10% Stroke progression - 5% Seizures - 4% In ischemic stroke patients who were followed over the course of 2-4 years, seizures developed in 6-9% of patients. [emedicine.com]
- Unable to Walk
Without the braces, she is unable to walk, and her legs get stuck in abnormal fixed positions. She has been told to come to terms, and accept that the wheelchair will be needed more and more. [yoocanfind.com]
[…] disability (requires some help, but able to walk without assistance); 4 = moderately severe disability (unable to walk without assistance and unable to attend to own bodily needs without assistance); 5 = severe disability (bedridden, incontinent, and [emedicine.com]
The diagnosis of LiS often becomes difficult as the signs and symptoms of the syndrome often mimic other diseases as well. In many cases, it takes as long as 2.5 years to appropriately diagnose the disease. Various neuroimaging tests should be carried out to rule out other disease conditions . In addition, imaging studies such as CT scan and MRI should be done to detect the location of the brain lesion.
Angiographic studies of the basilar veins using contrast enhanced imaging may effectively localize the lesions . In addition, confirmatory tests such as PET or functional MRI need to be carried out examine the cerebral functioning. EEG is also done that shows sleep wake patterns which is a characteristic feature for patients with LiS.
Locked-in syndrome cannot be cured and there is no standard treatment regime to treat the condition. Depending on the cause of the syndrome and nature of severity of the symptoms, treatment is tailor made for each individual.
The primary goal is to treat the underlying cause and employ methods to restore cognitive and motor functioning . Electrodes are used for stimulation of the muscle reflexes. In addition, Dasher technology is used for helping the individuals communicate. Recent advancements in the treatment methods have introduced mechanisms such as direct brain interface that helps patients answer yes–no questions. Treatment methods should also be channelized to prevent the onset of various systemic complications.
With appropriate initiation of treatment, the neurological functions such as horizontal eye movements begin to restore within the first four weeks. Younger individuals have a better prognosis than the adults. It has also been seen that, about 85% of affected individuals have a better survival rate with effective treatment and rehabilitation program. However, affected individuals often suffer from muscle stiffness and tightness also known as spasticity for the rest of their life.
The following are the several complications associated with Locked-in Syndrome:
Development of acute brainstem lesions is the most potential cause of Locked-in Syndrome. The lesions develop as a result of arterial thrombosis accompanied by obstruction of the affected artery. The other causes of LiS include the following:
- Brain hemorrhage
- Head injury affecting the brain
- Diseases such as multiple sclerosis
- Central pontine myelinolysis 
- Overdose of certain medications leading to toxicity (eg. magnesium) 
- Lou Gehrig’s disease
- Disorders of the circulatory system
- Thrombosis of the basilar artery 
- Psychological disorders 
- Cerebellar infarct 
In addition to the above mentioned causes, there have been certain pieces of evidence suggesting an association between cervical manipulation and artery dissection. However, such a kind of relation is not sufficiently backed up with research studies.
The exact incidence of Locked-in Syndrome is not recorded. However, with the available literature, it can be estimated that the onset of acute infections in patients with LiS was the cause of death in about 40% of the cases. The development of stroke was the primary cause of death in 25% of individuals with LiS.
Locked-in Syndrome is basically divided into 3 categories:
- Total LiS characterized by complete paralysis of the limbs, facial muscles including the eyes.
- Incomplete LiS wherein there are some limb movements with eye blinks and movements.
- Classical LiS wherein only eye movements are present.
LiS occurs due to damage to the lower portion of the brain along with the brainstem. The development of brainstem lesion is known to be the major cause of this syndrome. These lesions gravely affect the corticospinal tracts and cranial nerves IV and VI. When the facial nerves and lower cranial nerves are affected it specifically leads to paralysis of the facial muscles causing impaired speech with disruption of swallowing function.
So far no guidelines have been designed to prevent the onset of LiS. However, if the disease is diagnosed in its early stages and treatment initiated then complications can be prevented and significant restoration of cognitive and motor functions can be achieved.
Locked-in Syndrome, abbreviated as LiS, is a disease characterized by a state wherein the affected individual is awake and fully aware of the surroundings but is unable to react or communicate due to paralysis of the limbs and facial muscles . Such a syndrome is also known as pseudocoma and was first described in the year 1966 by Fred Plum and Jerome Posner.
In this condition limbs and facial muscles are paralyzed except the eyes. However, in total Locked-in Syndrome, the individuals are unable to move the eyes as well. Functions of breathing, phonation and swallowing may all be interrupted due to LiS.
Locked-in Syndrome (LiS) is a state of wakefulness wherein the patient is awake and aware of the surroundings but is unable to communicate due to paralysis of the limbs and facial muscles.
LiS precipitates as paralysis of the lower limbs and the facial muscles that greatly impairs the cognitive as well as motor functioning. Patients with LiS are unable to use their lower facial muscles which in turn cause inability to swallow, eat, talk and breathe. Eyes of the affected individuals are wide opened and can communicate only through vertical eye movements.
Diagnosis is made by carefully studying the clinical features followed by determination of the location of the brain lesion through imaging studies. Neuroimaging studies are also carried out to rule out the possibility of other disease conditions. EEG tests shows sleep wake pattern that confirms LiS.
Treatment of LiS is done by employing methods to treat the underlying disease conditions. Various methods such as Dasher technology and use of electrodes can be employed for restoring the cognitive and motor functioning. Patients are also given speech therapy to help regain their speaking ability.
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