Challenges when diagnosing locked-in syndrome following TBI: The Story of U.P. a Clinical Puzzle

Background and aims: Locked-in syndrome (LIS) is a rare neurological disorder; patients with LIS are awake, conscious with normal or nearly normal cognitive functioning. They cannot produce speech, facial or limb movements with complete paralysis of all voluntary muscles except for those controlling eye movements. LIS is associated with lesions of the brain stem and the pons, with 60% of people having sustained a stroke. LIS following traumatic brain injury (TBI) is rare; brain stem lesion plus cortical damage makes diagnosis of LIS challenging. Method: We describe U.P, a 42 year old man who sustained a TBI. A CT scan showed traumatic subarachnoid haemorrhage with a pre-pontine bleed. Awake, conscious, presenting with right sided paralysis and severe left sided paresis;U.P could produce voluntary horizontal eye movement, tracking people and stimuli of interest. Vertical eye movements emerged later, reading simple instructions and following commands. Results: U.P could use eyebrow movements for “yes” and a slight head shake for “no”. He could read some written instructions; non-verbal responses were inconsistent and sometimes unreliable. Discussion: Based on assessments from speech and language therapy and neuropsychology with U.P, we discuss LIS plus additional cognitive problems and the difficulties with diagnosing LIS following TBI.

HIPONATREMIA SEBAGAI PREDIKTOR PROGNOSIS KEMATIAN PASIEN CEDERA OTAK AKIBAT TRAUMA DI RUMAH SAKIT UMUM PUSAT (RSUP) DR. SARDJITO YOGYAKARTA

Latar Belakang: Insidensi cedera otak akibat trauma memiliki angka mortalitas mencapai 25%. Hiponatremia merupakan gangguan elektrolit yang paling sering terjadi pada pasien cedera otak akibat trauma yang dapat memperburuk kondisi dan dapat menjadi salah satu penyebab disabilitas/ mortalitas. Tujuan: Untuk menilai hubungan hiponatremia terhadap prognosis kematian pasien cedera otak akibat trauma di Rumah Sakit Umum Pusat (RSUP) Dr. Sardjito Yogyakarta. Metode Penelitian: Penelitian analitis menggunakan metode potong lintang terhadap data rekam medis pasiencedera otak akibat trauma di RSUP Dr. Sardjito selama bulan Desember 2016. Subjek penelitian terdiagnosis dan tercatat sebagai traumatic cerebral oedema (S06.1), traumatic subdural haemorrhage, (S06.5), dan traumatic subarachnoid haemorrhage (S06.6). Hasil: Terdapat 52 subjek dengan mayoritas laki-laki (76,9%), rerata usia 32 tahun, dan sebagian besar mengalami hiponatremia derajat sedang (61,5%). Jumlah pasien meninggal sebanyak 13,5%. Kadar natrium berpengaruh terhadap prognosis kematian pada pasien cedera otak akibat trauma (p=0,031).Simpulan: Hiponatremia berhubungan dengan prognosis kematian pasien cedera otak akibat trauma di RSUP Dr. Sardjito Yogyakarta.