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ABSTRACT
‘Locked-in syndrome (LIS)’ is a neurological disorder, often missed initially and can have grave consequences. A rare case of LIS caused due to folic acid deficiency-induced hyperhomocysteinemia is being described here. A 16-year-old boy presented with complaints of sudden onset weakness of all the four limbs with loss of voice for one day. All the tendon reflexes were increased, bilateral planters were extensor and sensory system was intact. Patient was conscious and responded to verbal commands by ocular movements in vertical direction. Hence, a diagnosis of LIS was made. Magnetic resonance imaging of the head revealed an acute infarct in ventral pons. Serum homocysteine level was elevated (20.65 μmol/l) and folic acid level was severely low (1.7 nmol/ml). Cause of LIS was found to be hyperhomocysteinemia induced stroke in the pons, related to folic acid deficiency. The patient was managed with antiplatelet agents and folic acid supplementation and was discharged subsequently. Recognition of LIS is important as casual remarks at bedside can severely traumatize an already paralyzed but conscious and awake patient. Folic acid deficiency can lead to hyperhomocysteinemia, which can cause strokes and even LIS. Prevention of hyperhomocysteinemia may possibly prevent such neurological disasters.
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No potential conflict of interest was reported by the authors.
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Notes on contributors
Satyendra Kumar Sonkar
Satyendra Kumar Sonkar is a Professor in the Department of Medicine at King George's Medical University, Lucknow, India. He has authored around 50 publications.
Satish Kumar
Satish Kumar is a Senior Resident in the Department of Medicine at King George's Medical University, Lucknow, India. He has 20 publications to his credit.
Neeraj Kumar Singh
Neeraj Kumar Singh is a Junior Resident in the Department of Medicine at King George's Medical University, Lucknow, India. He is an author in 2 publications.
Ruchika Tandon
Ruchika Tandon is a neurologist working as an Assistant Professor in the Department of Neurology at Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. She has 15 publications to her credit.