One-and-a-half syndrome in ischaemic locked-in state: a clinico-pathological study

Details

Serval ID
serval:BIB_AC3FEC922F8F
Type
Article: article from journal or magazin.
Publication sub-type
Case report (case report): feedback on an observation with a short commentary.
Collection
Publications
Institution
Title
One-and-a-half syndrome in ischaemic locked-in state: a clinico-pathological study
Journal
Journal of Neurology, Neurosurgery and Psychiatry
Author(s)
Bogousslavsky  J., Miklossy  J., Regli  F., Deruaz  J. P., Despland  P. A.
ISSN
0022-3050 (Print)
Publication state
Published
Issued date
09/1984
Volume
47
Number
9
Pages
927-35
Notes
Case Reports
Journal Article --- Old month value: Sep
Abstract
Five patients with "locked-in" syndrome and dysconjugate palsy of horizontal gaze were studied. In all cases internuclear ophthalmoplegia due to dysfunction or destruction of the median longitudinal fasciculus was combined with an ipsilateral gaze palsy, producing the "one-and-a-half" syndrome. Clinical and electro-oculographic examination suggested involvement of the paramedian pontine reticular formation when all ipsilateral saccades were abolished, when exotropia of the contralateral eye was present, and when vestibular stimulation showed full conjugate deviation to the damaged side. Involvement of the abducens nucleus was suggested when the palsy of ipsilateral gaze was not dissociated on vestibular stimulation. In three cases these clinical deductions were confirmed by the pathological study, which showed a corresponding destruction of the median longitudinal fasciculus, paramedian pontine reticular formation and abducens nucleus. In one case the one-and-a-half syndrome evolved into a total horizontal gaze palsy, which corresponded to involvement of the abducens nucleus contralateral to the initially destroyed paramedian pontine reticular formation. Vertical oculocephalic response disappeared, because of destruction of the median longitudinal fasciculus on both sides (bilateral internuclear ophthalmoplegia). Patients with the locked-in syndrome provide a unique situation in which complex pontine oculomotor disturbances may be studied, because consciousness is preserved. In these patients, dissociated and dysconjugate oculomotor palsy may have been underestimated.
Keywords
Brain/pathology Cerebral Arteries/pathology Cerebral Infarction/pathology Cranial Nerves/pathology Dominance, Cerebral/physiology *Eye Movements Humans Male Middle Aged Neural Pathways/pathology Ophthalmoplegia/*diagnosis/pathology Pons/blood supply Quadriplegia/*diagnosis/pathology Reticular Formation/blood supply Saccades Tomography, X-Ray Computed
Pubmed
Web of science
Open Access
Yes
Create date
25/01/2008 11:40
Last modification date
20/08/2019 15:16
Usage data