Which condition presents as mute, quadriplegic, bedridden, and communicates with eye movements only due to ventral pons and medulla infarction?

• A. Locked-in syndrome
• B. Persistent vegetative state
• C. Agnosia
• D. Prosopagnosia

Answer: (A)

Locked-in syndrome arises when there is bilateral ventral pontine infarction, often from basilar artery compromise, damaging the corticospinal and corticobulbar tracts. The person remains fully conscious and cognitively intact, but almost all voluntary movement is lost, leaving the individual mute and quadriplegic. Communication is possible only through eye movements and blinking, typically using vertical gaze, since the vertical eye motor pathways and blinking are spared. This combination—clear consciousness with near-total paralysis and preserved eye access to communicate—defines the presentation. This is distinct from a persistent vegetative state, where reliable communication and awareness are absent, and from perceptual disorders like agnosia or prosopagnosia, which affect recognition rather than motor function. Thus, the described scenario is classic for locked-in syndrome.