Thanatology: locked-in syndrome: practice question

A Forensic Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Forensic Medicine · Thanatology: locked-in syndrome

Sample item

After a basilar artery occlusion, a patient has quadriplegia and cannot speak, but moves his eyes vertically and blinks on command, and the EEG shows a normal waking pattern. Which state does he have?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Locked-in syndrome

A ventral pontine lesion interrupts motor pathways while sparing the reticular activating system and the vertical eye movement pathways, so the patient is awake and aware but can only communicate with the eyes. It must be distinguished from coma, vegetative state and brain death because the prognosis and the ethics are different.

Option by option

  • A. Persistent vegetative state

    A vegetative state has no awareness and no command-following responses.

  • B. Locked-in syndrome (correct)

    Correct. He is conscious and aware but paralysed except for eye movements.

  • C. Deep coma

    A deep coma gives no purposeful responses to command.

  • D. Brain stem death

    In brain stem death all brain stem function, including eye movement, is absent and the EEG is not normal.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Forensic Medicine question

What is the answer to this Forensic Medicine question?

The best answer is B, Locked-in syndrome. A ventral pontine lesion interrupts motor pathways while sparing the reticular activating system and the vertical eye movement pathways, so the patient is awake and aware but can only communicate with the eyes.

Why is "Persistent vegetative state" not the answer?

A vegetative state has no awareness and no command-following responses.

Why is "Deep coma" not the answer?

A deep coma gives no purposeful responses to command.

Why is "Brain stem death" not the answer?

In brain stem death all brain stem function, including eye movement, is absent and the EEG is not normal.

What concept does this question test?

It tests Thanatology: locked-in syndrome in Forensic Medicine. It must be distinguished from coma, vegetative state and brain death because the prognosis and the ethics are different.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Thanatology: locked-in syndrome?

Learn postmortem changes with their timelines, and toxicology as poison, sign, test and antidote. Then use the flashcards and the other Forensic Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.