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NEUROSURGICAL ANESTHESIA

Conversion Locked-In Syndrome After Implantation of a Spinal Cord Stimulator

David Han^*, Neil Roy Connelly, MD, Alan Weintraub, MD, Paul Kanev, MD, and Eddie Solis, DO

From the *Tufts University School of Medicine, Boston; and Departments of Anesthesiology and Neurosurgery, Baystate Medical Center; Springfield, Massachusetts.

Address correspondence and reprint requests to Neil Roy Connelly, MD, Department of Anesthesiology, Baystate Medical Center, 759 Chestnut St., Springfield, MA 01199, (413) 794-3520. Address e-mail to neil.roy.connelly{at}bhs.org.

BACKGROUND: The locked-in syndrome is defined as quadriplegia and anarthria (loss of articulate speech) with the preservation of consciousness. It is typically caused by a lesion to the ventral pons. Conversion disorder is the deficit of voluntary motor or sensory function requiring an extensive work-up to exclude any organic cause.

METHODS AND RESULTS: After surgery for an implantation of a spinal cord stimulator, a 42-year-old woman presented with quadriplegia and lower facial diplegia, but was able to open and blink her eyes. We found no organic causes to explain her condition after appropriate radiological studies looking for intracranial or intraspinal causes, and reversal drugs were administered with no immediate effect. Over the course of several hours, the patient gradually recovered and was discharged the following day. A psychology consultation was obtained during her stay and she was found to meet the criteria for a conversion disorder to explain her condition.

CONCLUSIONS: Before considering a psychological cause, all organic factors should be excluded with proper tests and consultations, as conversion disorder is a diagnosis of exclusion. We report a patient who, after implantation of a spinal cord stimulator, manifested locked-in syndrome resulting from a conversion disorder.