Locked-In Syndrome Due to Neuromyelitis Optica Spectrum Disorder in Acute Rehabilitation: A Case Report

Case Description 56-year-old female patient with prior questionable diagnoses of brainstem infarct, multiple sclerosis, and systemic lupus erythematosus who presented to the hospital with progressive dysarthria, lethargy, and weakness. MRI noted bilateral demyelinating lesions of the midbrain, pons, and middle cerebellar peduncles as well as nonspecific signal abnormality in the spinal cord at T6-T7. Her condition further deteriorated to flaccid complete tetraplegia. Communication was limited to extraocular movements and eye blinking. Serum aquaporin-4 antibody assay was positive. She was diagnosed with NMOSD resulting in transverse myelitis and locked-in syndrome. She was treated with IVIG and high-dose steroids and eventually plasma exchange. She completed 76 days of acute rehabilitation with a 3-day absence for rituximab infusions.https://jdc.jefferson.edu/rmposters/1012/thumbnail.jp