'Locked in' syndrome is the result of a bilateral lesion in the medulla due to occlusion of the penetrating midline branches of the basilar artery.
Characteristically, the patient is unable to talk, swallow or move the limbs despite being conscious and alert.
Some facial and eye movements are preserved permitting elementary communication.
Spinothalamic sensation is retained but discriminatory sensation in the limbs is lost due to damage to the medial lemniscus.
The prognosis is poor.
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