Subject(s)
Betacoronavirus , Coronavirus Infections/diagnostic imaging , Locked-In Syndrome/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Polyradiculoneuropathy/diagnostic imaging , Acute Disease , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/drug therapy , Humans , Immunoglobulins, Intravenous/administration & dosage , Locked-In Syndrome/complications , Locked-In Syndrome/drug therapy , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/drug therapy , Polyradiculoneuropathy/complications , Polyradiculoneuropathy/drug therapy , SARS-CoV-2ABSTRACT
Patients with a prolonged disorder of consciousness (DoC) may present with severe spasticity and diffuse pain, which might impair motor output, thus preventing any possible behavioral responsiveness. A 26-year-old man affected by frontoparietal hemorrhage was operated by hematoma evacuation and decompressive craniectomy; coma persisted for 1 month; cranioplasty and ventriculo-peritoneal shunting was performed after 4 months. At admission in rehabilitation, he was diagnosed as vegetative state/unresponsive wakefulness syndrome (VS/UWS). The implantation of intrathecal baclofen (ITB) pump (Medtronic SynchroMed™ II), 14 months after, (60 µg/daily), dramatically improved behavioral responsiveness according to Coma Recovery Scale-Revised (CRS-R) from 6 to 12 (1 month after ITB). Nociception Coma Scale-Revised (NCS-R) also changed from 4 to 8 at the same time points. This case report may be an example of covert cognition that should have been diagnosed as a functional locked-in syndrome or motor-cognitive dissociation, rather than as VS/UWS.
