LOCKED IN STATE AFTER TBI

F. Frank LeFever flefever at ix.netcom.com
Wed Jan 8 23:28:11 EST 1997


In <5b04h0$clg at rc1.vub.ac.be> mventura at resulb.ulb.ac.be (Manfredi
VENTURA) writes: 
>
>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.
>
>
>
I believe I replied directly to this query (i.e. not posted) a while
back, describing my experiences with a patient.  I'll reiterate one or
two points:
(1) yes, one must always act around and talk to the patient as one
would with anyone else, with of course tactful recognition of the
problem in responding.
(2) there are many atypical variations--my patient did NOT have much
eye control; paradoxically, he could sometimes make large movements
(e.g. catch something thrown at him!)
(3) degree of attention and/or motor control may vary widely from time
to time (perhaps particularly in atypical cases?)  Be alert for periods
of responsiveness and nonresponsiveness.

Frank LeFever
New York Neuropsychology Group







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