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Conversion Locked-In Syndrome After Implantation of a Spinal Cord Stimulator

Section Editor(s): Gelb, Adrian W.Han, David*; Connelly, Neil Roy MD; Weintraub, Alan MD; Kanev, Paul MD§; Solis, Eddie DO

doi: 10.1213/01.ane.0000250363.40356.b8
Neurosurgical Anesthesia: Case Report

BACKGROUND: The locked-in syndrome is defined as quadriplegia and anarthria (loss of articulate speech) with the preservation of consciousness. It is typically caused by a lesion to the ventral pons. Conversion disorder is the deficit of voluntary motor or sensory function requiring an extensive work-up to exclude any organic cause.

METHODS AND RESULTS: After surgery for an implantation of a spinal cord stimulator, a 42-year-old woman presented with quadriplegia and lower facial diplegia, but was able to open and blink her eyes. We found no organic causes to explain her condition after appropriate radiological studies looking for intracranial or intraspinal causes, and reversal drugs were administered with no immediate effect. Over the course of several hours, the patient gradually recovered and was discharged the following day. A psychology consultation was obtained during her stay and she was found to meet the criteria for a conversion disorder to explain her condition.

CONCLUSIONS: Before considering a psychological cause, all organic factors should be excluded with proper tests and consultations, as conversion disorder is a diagnosis of exclusion. We report a patient who, after implantation of a spinal cord stimulator, manifested locked-in syndrome resulting from a conversion disorder.

IMPLICATIONS: We report a patient who, after implantation of a spinal cord stimulator, manifested locked-in syndrome resulting from a conversion disorder. Before considering a psychological cause, all organic factors should be excluded with proper tests and consultations, as conversion disorder is a diagnosis of exclusion.

From the *Tufts University School of Medicine, Boston; and Departments of †Anesthesiology and §Neurosurgery, Baystate Medical Center; Springfield, Massachusetts.

Accepted for publication October 3, 2006.

Address correspondence and reprint requests to Neil Roy Connelly, MD, Department of Anesthesiology, Baystate Medical Center, 759 Chestnut St., Springfield, MA 01199, (413) 794-3520. Address e-mail to neil.roy.connelly@bhs.org.

© 2007 International Anesthesia Research Society