Overview
When the Patient Cannot Move but Can Answer
A patient with sudden quadriplegia and no speech may appear comatose.
CNPLE
CNPLE
A patient with sudden quadriplegia and no speech may appear comatose. If that patient opens the eyes to command, looks upward for yes and downward for no, or produces a consistent blink response, the apparent unresponsiveness may actually be a failure of motor output. Locked-in syndrome is the clinical result of this mismatch: awareness is preserved, but a pontine lesion interrupts most voluntary movement and speech. The assessment therefore has two simultaneous goals. First, identify a time-critical brainstem stroke and protect airway and oxygenation. Second, establish a dependable way for the patient to communicate before decisions are made on the patient’s behalf. A quiet, immobile patient is not necessarily an unaware patient.
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