The foot that spoke - Rehabilitation in Midbrain locked-in syndrome, a case report

Posterior circulation strokes account for approximately 20 percent of all ischemic strokes. Of these, 11 percent involve multiple arterial territories. Survivors of insult to multiple regions are left with extensive neurological deficits and present a unique challenge to the rehabilitation team. We present a case of recurrent posterior circulation stroke involving extensive areas of the brainstem, cerebellum, bilateral thalami and occipital cortex. Fluctuating sensorium and complete bilateral ophthalmoplegia along with anarthria and quadripariesis made initial assessment of level of consciousness difficult. The establishment of consistent communication and challenges posed to cognitive and physical rehabilitation are discussed.