Sindrome do encarceramento (locked-in syndrome): registro de um caso e revisão de literatura

Farage Filho, Miguel; Gomes, Mauro de Paiva

doi:10.1590/S0004-282X1982000300013

Resumos

É relatado um caso de síndrome do encarceramento (locked-in-syndrome) em paciente que apresentou quadro súbito de tetraplegia, anartria, movimentos oculares verticais e piscar além de preservação do nível de consciência. Explicação para tal quadro clínico é uma lesão na ponte junto ou sobre o núcleo do nervo abducente seccionando os tratos córtico-espinhal e córtico-bulbar, sem atingir a substância reticular do mesencéfalo. Três EEG revelaram distúrbio projetado por provável lesão do tronco cerebral, e que foi confirmada pelo CAT SCAN. Arteriografia vertebral mostrou grau avançado de aterosclerose. Com tratamento clínico conservador o paciente teve ótima evolução.

The case of a 46 year-old man who had a locked-in syndrome is reported. The patient had a haemorragic vascular accident with tetraplegia, anartria, vertical ocular moviments and preservation of the conciousness. The EEG showed a projected disturbance possibly caused by a braim-stem lesion, that was confirmed by the CAT SCAN. Cerebral angiography showed high level of aterosclerosis. The lesion is located in the ventral part of the pons above the nucleous of the abducent nerve, without damaging the substantia reticularis of the mesencephalon and can be caused by trombosis of the basilar artery and tumor, myastenia gravis, polyneurites, heroin overdose, after swine-flu inoculation and post-infectous polyneurites. The patient is still alive 2 years after the stroke with a good recovery. He can walk and speak fluently, but with cordonal ataxy of the limbs.

Sindrome do encarceramento (locked-in syndrome): registro de um caso e revisão de literatura

Locked-in syndrome: report of a case

Miguel Farage Filho; Mauro de Paiva Gomes

Neurocirurgiões. Hospital de Base do Distrito Federal (Brasília, D.F.)

RESUMO

É relatado um caso de síndrome do encarceramento (locked-in-syndrome) em paciente que apresentou quadro súbito de tetraplegia, anartria, movimentos oculares verticais e piscar além de preservação do nível de consciência. Explicação para tal quadro clínico é uma lesão na ponte junto ou sobre o núcleo do nervo abducente seccionando os tratos córtico-espinhal e córtico-bulbar, sem atingir a substância reticular do mesencéfalo. Três EEG revelaram distúrbio projetado por provável lesão do tronco cerebral, e que foi confirmada pelo CAT SCAN. Arteriografia vertebral mostrou grau avançado de aterosclerose. Com tratamento clínico conservador o paciente teve ótima evolução.

SUMMARY

The case of a 46 year-old man who had a locked-in syndrome is reported. The patient had a haemorragic vascular accident with tetraplegia, anartria, vertical ocular moviments and preservation of the conciousness. The EEG showed a projected disturbance possibly caused by a braim-stem lesion, that was confirmed by the CAT SCAN. Cerebral angiography showed high level of aterosclerosis. The lesion is located in the ventral part of the pons above the nucleous of the abducent nerve, without damaging the substantia reticularis of the mesencephalon and can be caused by trombosis of the basilar artery and tumor, myastenia gravis, polyneurites, heroin overdose, after swine-flu inoculation and post-infectous polyneurites. The patient is still alive 2 years after the stroke with a good recovery. He can walk and speak fluently, but with cordonal ataxy of the limbs.

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Trabalho do Hospital de Base do Distrito Federal (Brasília, D.F.).

Serviço de Neurocirurgia - Hospital de Base do Distrito Federal - Brasília - Brasil.

1. BARRAQUER-BORDAS, L. - Neurologia Fundamental, Editora Toray, Barcelona. 3Ş ed., págs. 164/169, 1976.
2. CARROL, W. N. & MASTAGLIA, F. L. - Locked-in coma post-infective polyneuropathy. Arch. Neurol. (Chicago) 86:46, 1979.
3. CHERINGTON, M., STEARS, J. & HODJES, J. - Locked-in syndrome caused by a tumor. Neurology (Minneapolis) 26:180, 1976.
4. CORDEAU, J. P. - Monorhythmic frontal delta actvity in the human electroencephalogram: a study of 100 cases. Eletroencephalogr. Clin. Neurophysiol. (Amsterdam) 11:733, 1959.
5. FELDMAN, M. H. - Physiological observations in a chronic case of "locked-in" syndrome. Neurology (Minneapolis) 21:459, 1971.
6. FLÜGEL, K. A.; FUCHS, H. H. & DRUSCHKY K. F. - Das "locked-in" Syndrom: pseudokoma bei Basilaristhrombose. Deutsche Medizinische Wochenschrift (Stuttgart) 102:465, 1977.
7. HAWKES, C. H. - Locked-in syndrome: report of seven cases. British Medical J. (London) 4:379. 1974
8. MILLER FISCHER, C. - Bilateral occlusion of basilar artery branches. J. Neurol. Neurosurg. a. Psychiat (London) 40:1182, 1977.
9. MOREL MAROGER, A. - Le syndrome "locked-in" ou pseudo-coma d'origine protubérantielle. Neurologie Encyclopedie Medico-chirurgicale. 17023 A 10. Paris, 1976.
10. NORDGREN, R. E.; MARKESBERY, W. R.; FUKUDA K. & REEVES A. G. - Seven cases of cerebromedullospinal disconnection: the "locked-in" syndrome. Neurology (Minneapolis) 21:1140, 1971.
11. PLUM, F. & POSNER, J. B. - The Diagnosis of Stupor and Coma. F. A. Davis Co, Philadelphia, 1966.

Datas de Publicação

Publicação nesta coleção
16 Ago 2012
Data do Fascículo
Set 1982

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. BARRAQUER-BORDAS, L. - Neurologia Fundamental, Editora Toray, Barcelona. 3Ş ed., págs. 164/169, 1976.

[2] 2. CARROL, W. N. & MASTAGLIA, F. L. - Locked-in coma post-infective polyneuropathy. Arch. Neurol. (Chicago) 86:46, 1979.

[3] 3. CHERINGTON, M., STEARS, J. & HODJES, J. - Locked-in syndrome caused by a tumor. Neurology (Minneapolis) 26:180, 1976.

[4] 4. CORDEAU, J. P. - Monorhythmic frontal delta actvity in the human electroencephalogram: a study of 100 cases. Eletroencephalogr. Clin. Neurophysiol. (Amsterdam) 11:733, 1959.

[5] 5. FELDMAN, M. H. - Physiological observations in a chronic case of "locked-in" syndrome. Neurology (Minneapolis) 21:459, 1971.

[6] 6. FLÜGEL, K. A.; FUCHS, H. H. & DRUSCHKY K. F. - Das "locked-in" Syndrom: pseudokoma bei Basilaristhrombose. Deutsche Medizinische Wochenschrift (Stuttgart) 102:465, 1977.

[7] 7. HAWKES, C. H. - Locked-in syndrome: report of seven cases. British Medical J. (London) 4:379. 1974

[8] 8. MILLER FISCHER, C. - Bilateral occlusion of basilar artery branches. J. Neurol. Neurosurg. a. Psychiat (London) 40:1182, 1977.

[9] 9. MOREL MAROGER, A. - Le syndrome "locked-in" ou pseudo-coma d'origine protubérantielle. Neurologie Encyclopedie Medico-chirurgicale. 17023 A 10. Paris, 1976.

[10] 10. NORDGREN, R. E.; MARKESBERY, W. R.; FUKUDA K. & REEVES A. G. - Seven cases of cerebromedullospinal disconnection: the "locked-in" syndrome. Neurology (Minneapolis) 21:1140, 1971.

[11] 11. PLUM, F. & POSNER, J. B. - The Diagnosis of Stupor and Coma. F. A. Davis Co, Philadelphia, 1966.