A Case of Locked-in Syndrome with Hypoglycemia

ABSTRACT

Locked in syndrome (LIS) is a state of tetraplegia and lower cranial nerve palsies in which vertical eye movement and blinking are the only means of communication, but consciousness is preserved. LIS is most frequently a sequelae of a basilar artery thrombosis lesion and may be caused by trauma, hemorrhage, a tumor, infection, etc., which results in a ventral pontine lesion or bilateral midbrain lesion. Early diagnosis and treatment must be a priority because the recovery of patients with locked in syndrome caused by a basilar artery occlusion is exceptional, with a 65~75% mortality. Although an improved clinical outcome can be achieved in patients with a basilar artery occlusion by early recanalization after the use of thrombolytic therapy or angioplasty, early diagnosis and treatment of this state is difficult, for the neurologic deficits develope gradually. The diagnosis of LIS in patients who present with hypoxia, metabolic disorder, endocrine disorder, central nerve system disorder, acute alcohol intoxication, acute drug intoxication, etc may be missed. At the emergency department, closer attention and frequent neurologic examinations must be given to patients who complain of altered mental state. We report a case of LIS which was misdiagnosised as hypoglycemic encephalopathy and review the literature.