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August 1980

Hyperbaric Chamber Treatment for 'Locked-in' Syndrome

Author Affiliations

From the Harry M. Dent Neurologic Institute, Millard Fillmore Hospital, Buffalo (Drs Newman and Manning), and the Department of Neurology, State University of New York at Buffalo (Dr Manning).

Arch Neurol. 1980;37(8):529. doi:10.1001/archneur.1980.00500570077017

The "locked-in" syndrome described by Plum and Posner is characterized by quadriplegia and bulbar and facial paralysis.1 Pathologic findings are those of infarction of the ventral pons bilaterally, usually due to thrombotic or embolic occlusion of the basilar artery.2-3 We describe a patient in whom the locked-in syndrome developed after operation to establish an aortocoronary bypass and who subsequently recovered completely with hyperbaric oxygenation. It is likely that air embolization was the cause of the locked-in syndrome in this patient.

REPORT OF A CASE  A 54-year-old man with a history of two myocardial infarctions and hypertension was hospitalized with crushing substernal chest pain. Coronary angiography revealed severe coronary atherosclerosis. On two occasions during aortocoronary bypass surgery, the surgeon noted small air bubbles in the grafts, and evacuation was attempted by aspiration through a 25-gauge needle. Each time the air bubbles were observed, cardiac action deteriorated, and on the