Stupor resolving into rapidly deteriorating locked-in syndrome: Early magnetic resonance imaging brain in diagnosis

Locked-in syndrome (LiS) is a rare condition characterized by quadriplegia, lower cranial nerve paralysis, and mutism with preservation of consciousness, vertical gaze, and upper eyelid movement. Here, we present a case that had initial mild neurological symptoms, stupor, fully conscious state, and computed tomography-brain showing old cerebral infarcts. There was a rapid deterioration of the condition into LiS and magnetic resonance imaging (MRI) brain showing infarcts bilaterally in the cerebellum, pons, midbrain, and thalami and finally leading to death. Relevant studies for discussion are presented. This case highlights the importance of MRI brain at the earliest even for cases with initial mild neurological symptoms and stupor to make an early diagnosis.