Locked in Syndrome After Penetrating Traumatic Brain Injury

We report a case of locked in syndrome after direct injury to the ventral pons following penetrating trauma. Locked in syndrome is a devastating and rare neurologic disorder that most commonly occurs after cerebrovascular accident involving the basilar artery. Traumatic etiology is rare but in previously reported cases has involved blunt vascular injury as the immediate cause. We present a case of a young male who suffered a penetrating wound to the pons that resulted in locked in syndrome. The diagnosis was confirmed by thorough physical examination, CT and MR imaging, and digital subtraction angiography. Locked in syndrome is an exceptionally rare entity in trauma. Prompt diagnosis requires careful physical examination and high clinical suspicion after appropriate mechanism of injury.