Locked In Syndrome: Looking Inside It, A Case Report
Asmell Ramos Cabrera, Humberto Acosta Pupo, Kehinde O Oduntan, Rainier Paulino, Mayelin Martinez, Jennifer Shallop and Onyia Onyema
Locked-in syndrome (LIS) is well known to the public, since the masterful description of Alexandre
Dumas. Additionally, Émile Zola reflected this condition in one of his characters, and later, others
did as well [1]. In medical practice it is considered a rare neurological disease, with an incidence
and a prevalence that is difficult to determine. It affects both sexes and is more common in adults,
basically as a complication of cerebrovascular diseases (CVD). Patients with classic LIS develop
quadriplegia, but normally remain conscious and can communicate by blinking, constituting the most
dramatic presentation of brain stem involvement. To diagnose it is challenging because of its similarity
to conditions such as akinetic mutism, coma, persistent vegetative state, psychogenic pseudocoma,
or brain death. There have been cases reported that have taken months and even years to establish a
definitive diagnosis. The CVD incidence rate in Africa is among the highest incidence in the world,
with West Africa (WA) being the largest. Paradoxically, no reports of LIS associated with CVD have
been found in the subregion. Our goal is to document the first case in WA of a patient with classic-type
locked-in syndrome, secondary to acute pontine ischemic infarction, associated to severe vitamin B
deficiency, and accompanying with acute osmotic demyelination syndrome. Which was a result of the
intensive correction of severe hyponatremia. A case that is difficult to manage and complex to diagnose,
which makes it especially interesting for our professionals. Recognizing the disease will avoid delays
in diagnosis and facilitate early intervention, reducing associated complications and mortality, which
remains high in the initial phases. Then, together with a multidisciplinary team, achieve the best possible
social reintegration of patients, knowing in advance the serious limitations they will face in their future.
