{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,3]],"date-time":"2025-08-03T03:59:12Z","timestamp":1754193552364,"version":"3.41.2"},"reference-count":41,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100011852","name":"Paracelsus Medizinische Privatuniversit\u00e4t","doi-asserted-by":"publisher","award":["Research and Innovation Fund \u2013 PhD Researcher Ex"],"award-info":[{"award-number":["Research and Innovation Fund \u2013 PhD Researcher Ex"]}],"id":[{"id":"10.13039\/501100011852","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ther Adv Neurol Disord"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:p> The locked-in syndrome (LiS) is defined as the loss of most voluntary muscle movements with preserved cognitive abilities due to a ventral pontine lesion. However, some patients may also have severe impairment of consciousness [locked-in plus syndrome (LiPS)]. Here we aimed to explore structural differences between LiS and LiPS patients of vascular aetiology, focusing on lesion patterns and locations to better delineate the clinical spectrum of LiS and LiPS. In this retrospective case series study, we report nine patients (two women), ages 29\u201374\u2009years (median 50) with LiS and LiPS who were diagnosed between 2007 and 2021. Clinical parameters, MRI findings including the lesioned structures, and a shape feature calculation are presented for every patient. The lesioned structures were determined by a senior neuroradiologist. Two of nine patients had fully retained consciousness (LiS) and seven showed various degrees of impaired consciousness (LiPS). Lesions of LiS patients are round and confined to the pons, whereas lesions of LiPS patients are more elongated and reach neighbouring areas such as the mesencephalon, thalamus or ascending reticular activating system. Lesions involving the mesencephalon and the thalamus are strong indicators of LiPS, whereas for lesions restricted to the pons, the dorsal extension and the associated damage to the ascending reticular activating system are crucial to differentiate LiS from LiPS. Recognizing LiPS using clinical and radiological findings is important as these patients may need different therapies and care and, most importantly, should not be mistaken as unresponsive wakefulness syndrome. <\/jats:p>","DOI":"10.1177\/17562864231207272","type":"journal-article","created":{"date-parts":[[2023,11,16]],"date-time":"2023-11-16T09:43:15Z","timestamp":1700127795000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["The vascular locked-in and locked-in-plus syndrome: A retrospective case series"],"prefix":"10.1177","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8152-7186","authenticated-orcid":false,"given":"Laura","family":"Schnetzer","sequence":"first","affiliation":[{"name":"Department of Neurology, Neurological Intensive Care and Neurorehabilitation, Christian Doppler Medical Centre, Paracelsus Medical University, Ignaz-Harrer-Stra\u00dfe 79, Salzburg A-5020, Austria"},{"name":"Neuroscience Institute, Christian Doppler Medical Centre, Centre for Cognitive Neuroscience Salzburg, Paracelsus Medical University, Salzburg, Austria"},{"name":"Karl Landsteiner Institute of Neurorehabilitation and Space Neurology, Salzburg, Austria"},{"name":"Spinal Cord Injury and Tissue Regeneration Centre, Paracelsus Medical University, Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00fcrgen","family":"Steinbacher","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Christian Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerhard","family":"Bauer","sequence":"additional","affiliation":[{"name":"Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander 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