Locked-in Syndrome After Pontine Hemorrhage in an Amphetamine Abuser

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A 37-year-old woman was discovered comatose with extensor synergies. She was intubated and delivered to our emergency department, where her systolic blood pressure was found to be in excess of 230 mm Hg. Multimodal cranial computed tomography showed a pontine hemorrhage with slight invasion of the fourth ventricle in the absence of indicative vascular pathology (Figure a). After cessation of sedation, the patient was tetraplegic; painful stimulation of the extremities resulted in mild extensor synergies. The patient opened her eyes on request, and strictly vertical eye movements and eyelid movements with non-verbal communication were possible (Figure b). We diagnosed locked-in syndrome with an etiology of pontine hemorrhage owing to amphetamine consumption, the latter confirmed by clinical chemistry. Based on information from others, use of “speed” was suspected. Cranial magnetic resonance imaging failed to demonstrate any vascular malformation or possibly malignant lesion. Amphetamine abuse is a common cause of hemorrhagic infarctions in young patients (13%), and the clientele should be made aware of the risk. Pathophysiologically, there is marked elevation of blood pressure and toxic vascular injury/inflammation. The patient was transferred for rehabilitation and fortunately regained rollator-dependent mobility and limited verbal communication.

Dr. med. Patrick Heinz, Dr. med. Björn Wolf, Klinik für Neurologie und klinische Neurophysiologie, Bundeswehrkrankenhaus Ulm, [e-mail]

Dr. med. Sonja Schuldes, Klinik für Radiologie und Neuroradiologie, Bundeswehrkrankenhaus Ulm

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by David Roseveare..

Cite this as: Heinz P, Schuldes S, Wolf B: Locked-in syndrome after pontine hemorrhage in an amphetamine abuser. Dtsch Arztebl Int 2024; 121: 330. DOI: 10.3238/arztebl.m2023.0330