Strokes are one of the most common causes of locked-in syndrome. These strokes affect the brain stem. Doctors often call them pontine strokes because they specifically affect an area of the brain stem known as the pons. When a stroke disrupts blood flow to the pons, it prevents the brain from communicating with the spinal cord and nervous system. This causes symptoms of locked-in syndrome.
Understanding the Causes of Locked-In Syndrome
In most cases, locked-in syndrome occurs following some injury or damage to the pons. The pons is a key structure in the brain stem that provides a pathway for communication between the cerebrum, cerebellum, and spinal cord. Most of the body’s motor fibers run through this area. Because of this, damage to the pons can prevent the brain from sending signals to the rest of the body to produce intentional movement.
The pons also plays a role in controlling breathing and the nerve communication necessary to speak, swallow, and make most facial movements. Vertical movement of the eyes is sometimes the only movement that remains following damage to the pons. Some people can also move their eyes horizontally or blink while others retain no movement at all.
Damage to the pons can occur in several ways. Most commonly, this includes:
- A stroke caused by a blood clot
- A stroke caused by another blockage of blood flow
- A stroke caused by hemorrhage
- A stroke related to trauma to the brain
Diagnosing a Locked-in Stroke and Locked-In Syndrome
It is imperative that doctors recognize a pontine stroke as quickly as possible. A crucial factor in survival is getting immediate medical care including medications to break up the blood clot or otherwise stop the stroke from doing more damage. Restoring blood flow to the brain stem as soon as possible could limit the damage done and save their life.
It may be possible to diagnose a pons stroke by observation and medical imaging such as magnetic resonance imaging (MRI) and magnetic resonance angiography. These tests allow doctors to visualize what is happening inside the pons and locate a blood clot or another blockage.
Additional tests are necessary to diagnose locked-in syndrome. While observation plays a key role in this diagnosis, doctors also run tests to look at brain activity and to document sensation and nerve conduction.
Living with Locked-In Syndrome
A locked-in stroke may initially cause the person to slip into a coma. After several days, they may wake up but remain in a pseudocoma state. This means they are cognitively intact but unable to move or communicate except using vertical eye movements and blinking. They may need medical intervention and support for a wide variety of tasks including:
- Breathing
- Feeding
- Emptying their bladder and bowels
- Hygiene
- Communication
Locked-in syndrome is another name for this type of pseudocoma. Depending on the damage the stroke did to the pons, a patient can suffer from:
- Classic locked-in syndrome, only retaining vertical eye movements and blinking
- Complete locked-in syndrome, retaining no purposeful movement
- Incomplete locked-in syndrome, retaining vertical eye movement, blinking, and other purposeful movements
Those with classic or incomplete locked-in syndrome can often learn to communicate with their care providers and loved ones, improving their quality of life dramatically. Patients with complete locked-in syndrome cannot generally communicate with those around them, although brain/computer interfaces currently in testing may allow it in the future.
Treatment and Recovery After a Locked-In Stroke
There is no treatment or cure for locked-in syndrome after the stroke occurs and the patient becomes locked in. Doctors and therapists provide supportive care and therapy to help patients build on any small movements they may retain. While many learn to breathe on their own and communicate using eye gaze devices or blink codes, significant recovery is rare. Some people can regain enough movement to move a power wheelchair.
Preventing a pons stroke is the best way to prevent this type of outcome. Those at an increased risk for this type of stroke are the same people who have an increased risk for other types of strokes. This includes:
- Having a family history of stroke
- Being overweight or obese
- Smoking
- Having high blood pressure or high blood cholesterol levels
- Having diabetes
- Drinking regularly
- Having a previous stroke
You May Be Able to Pursue Legal Action After a Locked-In Stroke
If you or a loved one suffered a pontine stroke and now lives with locked-in syndrome, the attorneys from Newsome | Melton want to review your case. You may qualify to pursue compensation based on the facts of your case. This could be possible through a medical malpractice claim or personal injury lawsuit.
If your doctor failed to diagnose or treat your locked-in stroke quickly, you could pursue a payout that would cover your medical care, ongoing care costs, medical and communication devices, pain and suffering, and more. Call us today at (800) 917-5888 for a no-cost evaluation.