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March 1976

Eye Findings in the "Locked-In" Syndrome

Author Affiliations

Division of Neurology, Dept of Med Dartmouth-Hitchcock Med Center Hanover, NH 03755

Arch Neurol. 1976;33(3):215. doi:10.1001/archneur.1976.00500030071017

To the Editor.—  In a recent issue of this journal (Arch Neurol 32:695, 1975), James R. Keane describes a phenomenon he terms "spastic eyelids." This clinical finding is attributed to failure of inhibition of the third nerve nuclei innervating the levator palpebrae muscles. The first case described concerns a 55-year-old man, apparently in coma, with a flaccid quadriplegia and no spontaneous respirations. The pupils were 2 mm in diameter and reacted to light. The eyes were noted to be in continuous conjugate vertical motion of irregular amplitude and frequency. No voluntary or reflex horizontal eye movements were elicited. Testing of voluntary and reflex vertical eye movements was not reported. Electroencephalogram revealed bilateral slowing initially and, later, continuous alpha wave activity that blocked for up to ten seconds with the removal of eye patches. The patient was sustained on a respirator for seven months. Pathologic findings reported thrombosis of a fusiform basilar