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Abstract
Locked-in syndrome (LIS) is a severe neurological condition characterised by tetraplegia and anarthria, with preserved consciousness and vertical eye movements. It often results from bilateral pontine infarctions, which sometimes demonstrate a characteristic ‘heart appearance’ sign on MRI. We report a case of a mid-60s female with acute onset LIS and dyspnoea. Clinical examination suggested a pontine infarction, later confirmed by an MRI scan revealing a characteristic ‘heart appearance’ on axial diffusion-weighted imaging sequence. As the patient presented within the thrombolysis time window and had no contraindications, alteplase was administered. The patient demonstrated an exceptional neurological improvement within 10 days of hospitalisation, transitioning from tetraplegia and anarthria to moving all four limbs against gravity and mild dysarthria. She was subsequently discharged to a rehabilitation centre. This case underscores the efficacy of timely thrombolysis in severe pontine strokes and highlights the diagnostic significance of MRI findings in such cases.
- Brain stem / cerebellum
- Neuroimaging
- Stroke
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Footnotes
Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: FN, EK, EV, EP. EP is the guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.