Locked Man Syndrome is a rare neurological disorder, which is complete paralysis of all arbitrarily contracting muscles. Only the muscles responsible for eye movements remain unaffected. Patients with this pathology remain conscious, but lose the ability to move (not counting the eyes) and speak (aphonia). Cognitive function usually does not suffer. The patient is able to communicate through the eyes, including blinking for centuries. The violation occurs due to damage to the Varolian bridge - part of the brain stem, consisting of nerve fibers responsible for transmitting information to other fragments of the brain. Since the patient appears to be captured by his own body, the pathology is called "locked-in syndrome."
Signs and Symptoms
People who are in a pseudocom (the second name for the violation) are usually not able to consciously chew, swallow, breathe, speak or move. The ability to move is preserved only in the eyelids and eyeballs, as a result of which patients can make vertical eye movements. At the same time, movements in the horizontal plane (from side to side, and not up and down) remain impossible. People in a pseudocom are bedridden and entirely dependent on carers and treatment. Despite physical paralysis, the cognitive function of the brain remains intact.
Patients with a diagnosis of "locked-in syndrome" are fully aware of everything that happens around. They can see and hear, and maintain their usual sleep and wake cycles. Communication is possible through eyeball movements or blinking; both gestures are often used. People in the pseudocom well understand the meaning of everything that they are told or read.
Most often, victims are initially in a state of coma. Then, consciousness gradually returns to them, however, patients remain paralyzed and incapable of active life.
Causes
If you are interested in locked-up syndrome, a doctor with a specialization in neurology can talk about the causes of this condition. Most often, it arises as a result of damage to the Varolian bridge - a storehouse of important neural pathways between the cerebral hemispheres, the spinal cord and the cerebellum. With this diagnosis, interruption of all motor nerve fibers coming from the gray matter in the brain through the spinal cord to the muscles is observed. The centers of the brain stem, which play a key role in the functioning of the facial muscles and articulation of speech, are also damaged.
Damage to the Varolian bridge, which provokes the syndrome of a locked person, the treatment of which is described below, can occur due to a heart attack or hemorrhage. In rare cases, a pseudocom may be caused by a head injury.
Diagnostics
Since a neurologist can independently determine the syndrome of a locked person with high accuracy, the diagnosis is often carried out in a clinical setting. To differentiate the pathology from a number of other disorders with similar symptoms, special studies are carried out. So, MRI is considered mandatory - magnetic resonance imaging, which is able to visually show damage to the Varolian bridge, and magnetic resonance angiography is the best way to detect blood clots in the arteries of the brain stem. In addition, these studies help detect other brain damage.
An electroencephalogram, which is a method of measuring the electrical activity of the brain, can prove the fact of normal brain activity and the preservation of sleep and wake cycles in patients with a diagnosis of locked-up syndrome.
Treatment
Any treatment should be primarily aimed at eliminating the cause of the pathology. For example, the elimination of a blood clot (thrombus) in the basilar artery by the method of intra-arterial thrombolytic therapy can be carried out within the first six hours after the appearance of typical symptoms.
Often in the first months of a pseudo-coma, patients need special equipment to ensure continuous breathing. In most cases, a tracheotomy is performed - an opening of the trachea, after which a tube is inserted into the airways to ensure direct air into the lungs.
Consuming food and drink by mouth is not possible, as it can cause respiratory infections due to food entering the lungs instead of the stomach. Therefore, it may be necessary to carry out another operation - a gastrostomy, in which an artificial lumen is made in the stomach for the introduction of food and water through the tube.
Contact
It is important to invent a communication system with the victim as soon as possible. Carers, as well as relatives and friends, should try to make contact as soon as possible in order to find out in time about all the needs of the bedridden patient. Unfortunately, with the diagnosis of locked-in syndrome, the prognosis is extremely disappointing: this condition cannot be cured, although in some cases, over time, people gain the ability to gradually contract facial muscles. Modern technologies are developing very fast - it is quite possible that soon scientists will invent a computerized method of communicating with people who have fallen into a pseudo-coma.
Since computerization has not yet achieved such progress, in each individual case, one should develop his own system of contact with the patient. It is recommended to start with the simplest encoding: for example, a look up means approval or agreement, a look down indicates disagreement or denial. In a condition such as locked-in syndrome, rehabilitation begins with a small one, but gradually more complex codes transmitted by eye movements can be used in communication. The use of the alphabet is also possible; often, relatives distribute vowels and consonants in separate columns and wait until the patient “calls” the column first with a look and only then with the specific letter. It is known that individuals, despite being in a pseudo-committee, wrote poems in this way.
To live on
It must be remembered that locked-in syndrome is by no means a sentence. With due care from relatives, friends or hospital staff and high-quality technical support, a patient even with such a diagnosis can lead a decent life.