• Thomas M Johnson, Cynthia S Romero, and Austin T Smith.
• Department of Emergency Medicine, Vanderbilt University Medical Center, 1313 21st Ave, South, 703 Oxford House, Nashville, TN 37232-4700, United States of America.
• Am J Emerg Med. 2018 Oct 1; 36 (10): 1928.e5-1928.e7.

AbstractLocked-in syndrome (LIS) is an exceedingly rare condition that has been described as a fate worse than death. Unfortunately, exam findings can be subtle and imaging is poorly sensitive, often leading to a delay in diagnosis. We present a case of a 70-year-old female who presented to our emergency department after developing respiratory distress followed by sudden unresponsiveness. She was diagnosed with LIS and had an immediate and remarkable improvement after administration of tissue plasminogen activator (TPA). Patients presenting with sudden onset altered mental status require a very careful physical exam, even if deemed comatose, and should be considered for emergent imaging for stroke. Fortunately, our patient recovered well and was discharged home in good condition.Copyright © 2018 Elsevier Inc. All rights reserved.

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