LOCKED IN STATE AFTER TBI

Manfredi VENTURA mventura at resulb.ulb.ac.be
Wed Jan 8 07:38:56 EST 1997


In article <32B8779D.30A6 at cybrtyme.com>, norednex at cybrtyme.com says...
>
>Can anyone help me with some information about the "Locked In" state
>after a TBI??
>A short synopsis of what it entails?
>Please respond, my precious "adopted" son dAniel has emerged from his
>coma, but may be Locked In.
>karen suzanne
>norednex at cybrtyme.com



The locked-in-state is a neurological syndrome where the patient is alert 
(fully conscious) but quite unable to demonstrate this to the outside (he seems 
to be in coma but he is not).
It is usually caused by lesion(s) in the brainstem (the anatomical region 
between the brain and the spinal cord) which block the brain impulses to go to 
the cranial nerve and the lower part of the body prohibiting so all voluntary 
movement; and block the peripheral impulse to reach the brain (suppressing all 
sensation (below the head)). In these case, the patient is usually only able to 
communicate with eyes movements or by blinkink his eyelids (e.g. one blink to 
say "no", 2 blinks to say "yes").
It is important to know that these patients usually understand what people are 
saying aroud them.
Peripheral involvement of the nervous system, as severe Guillain Barré syndrome 
can sometimes lead to this condition.It is quite unusual after TBI which 
typically produces conscioussness impairment whith more or less severe coma 
(locked-in-state is not a coma)  but it could happen when the patient "awakes" 
from his original coma, if he has sustained severe and strategically located 
brainstem lesion.
An expererienced physician should do the difference between coma / stupor and 
locked-in-state.

A good reference on this topic is the book "Diagnosis of stupor and coma" (I do 
not have it here close to me, so my memory could give me an approximative 
title) by Plum and Posner.
If you need more accurate references just ask me.

Good luck and all my whishes of prompt recovery fo Daniel.






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