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Locked-in Syndrome and 18F-fluorodeoxyglucose-positron Emission Tomography/Computed Tomography: Observations from a Case of Basilar Artery Thrombosis
Angelina Cistaro1, Giuliano Lo Bianco2, Piercarlo Fania3, Simone Margotti3, Simone Vigneri4, Cristina Geraci2, Natale Quartuccio5
1 Positron Emission Tomography Centre IRMET S.p.A., Affidea, Turin; AIMN Neuroimaging Study Group, Milan, Italy
2 Department of Biopathology and Medical Biotechnologies, Section of Anesthesia, Analgesia, Intensive Care and Emergency, University Hospital Paolo Giaccone, University of Palermo, Italy
3 Positron Emission Tomography Centre IRMET S.p.A., Affidea, Turin, Italy
4 Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo; Department of Neurology, Santa Maria Maddalena Hospital and Advanced Algology Research, Occhiobello, Italy
5 Wolfson Molecular Imaging Centre, University of Manchester, Manchester, England, UK
Correspondence Address:
Dr. Angelina Cistaro
Positron Emission Tomography Centre IRMET S.P.A., Affidea, V. O. Vigliani 89, Turin 10136
Italy
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijnm.IJNM_85_17
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We report the case of a 59-year-old male patient suffering from locked-in syndrome (LIS) following basilar artery thrombosis despite an attempt of thrombolysis. Neurological examination showed quadriplegia and aphonia and a state of coma requiring mechanical ventilation was diagnosed. The use of 18F-fluorodeoxyglucose (18F-FDG)-positron emission tomography (PET) allowed to detect a normal 18F-FDG uptake in the main cerebral cortical areas and a significant reduction of 18F-FDG uptake in both cerebellar hemispheres, compatible with a functional deafferentation, helping confirming the clinical suspicion of LIS. The diagnosis of LIS, according to literature, is based on the clinical assessment and the utilization of scores as the Coma Recovery Scale-Revised. The standard neuroimaging techniques, although recognize the site of injury, are not able to differentiate the different conditions affecting a state of altered consciousness. Performing 18F-FDG-PET in patients with LIS might help addressing the correct diagnosis and prompting subsequent appropriate treatment, and therefore, ultimately improving the patient outcome. Therefore, 18F-FDG-PET should be taken into account in the early clinical assessment of doubtful cases.
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