Integrative Biomedical Research
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Contents Vol 8 (8)

Locked-in Syndrome in Emergency Care Settings – A review of Clinical Challenges and Management Strategies

Osama Faraj Shaleh Alotaibi1, Abeer Mohammed Alshami2, ‏Noura Thani Alrasheedi2, ‏Ibrahim Abdu Aljabri2, ‏Hala Abdulaziz Alzuhair2, ‏Thamer Farhan Alanazi2, ‏Mohammed Abdullah Aljalil2, ‏Abdullah Ali Thamari2, ‏Maryam Abdulrahman Al-Mutairi2, ‏Abdulrhman Ali Almazam2, ‏Tahany Mohammed Owdh Alshehri2, ‏Mohammed Ahmed  Hadadi2, ‏Wadha Siar Al-Anazi2, ‏Fahad  Ayidh  Al Qarni2, ‏Braik  Dafer Al Qarni2, ‏Ali Saleh Alghamdi 2, Rakan khlied Alotaibi 3

+ Author Affiliations

Integrative Biomedical Research 8 (8) 1-8 https://doi.org/10.25163/angiotherapy.8810293

Submitted: 04 June 2024 Revised: 06 August 2024  Published: 08 August 2024 

Abstract

Background: Locked-in syndrome (LIS) is a rare neurological disorder characterized by complete paralysis of voluntary muscles, except for preserved vertical eye movements and blinking, while cognitive function remains intact. It primarily results from damage to the ventral pons, often due to vascular insults, trauma, infections, or demyelinating diseases. Despite its severity, LIS is frequently misdiagnosed as akinetic mutism or coma, leading to delays in appropriate care.

Aim: This article explores the clinical challenges, diagnostic approaches, and management strategies for LIS in emergency and long-term care settings, emphasizing early recognition and multidisciplinary intervention to improve patient outcomes.

Methods: A comprehensive review of LIS etiology, pathophysiology, and diagnostic criteria was conducted, incorporating neuroimaging (CT, MRI), cerebrospinal fluid analysis, electrophysiological studies (EEG, EMG), and clinical assessments. Treatment strategies were evaluated based on acute stabilization, etiology-specific interventions, and rehabilitative care.

Results: Vascular causes, particularly basilar artery strokes, account for most LIS cases. Early diagnosis through neuroimaging and structured neurological exams is critical. While motor recovery is limited, rehabilitative strategies—including speech therapy, assistive communication devices, and physical therapy—enhance quality of life. Long-term survival depends on etiology, with nonvascular cases showing better functional recovery.

Conclusion: LIS requires prompt diagnosis and a multidisciplinary approach to optimize patient outcomes. Advances in assistive technology and rehabilitation offer hope for improved communication and independence, challenging the historical perception of LIS as a hopeless condition.

Keywords: Locked-in syndrome, brainstem stroke, neurorehabilitation, assistive communication, multidisciplinary care.

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