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Isolation Syndrome: Causes, Symptoms, Diagnosis, Treatment

Alexey Portnov, medical expert
Last reviewed: 23.04.2024

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Isolation syndrome (synonyms: state of de-referentia, locked-up syndrome, ventral pontine syndrome, wakeful coma) is a state with a preserved wakefulness and orientation with loss of facial expressions, movements, and speech. Communication is possible only through eye movements.

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What causes isolation syndrome?

The isolation syndrome develops as a result of a stroke that damages the bridge with damage to the centers involved in providing a horizontal look.

Symptoms of the syndrome of isolation

Cognitive functions are not violated, the patient is conscious, can open his eyes, sleep and stay awake, but is unable to move the lower half of his face, chew, swallow, speak, breathe and move his limbs. The patient can move his eyes in a vertical direction and blink a specified number of times in response to questions.

Diagnosis of isolation syndrome

The diagnosis is mainly based on the clinical picture. With the help of neuroimaging, you can determine the cause of the condition and track its dynamics over time. EEG is normal during wakefulness and sleep.

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Treatment of isolation syndrome

Most patients die within a month, recovery to an independent condition is rare, but if the cause is partially reversible (for example, severe widespread paralysis in Guillain-Barre syndrome), it can occur in a few months. Among positive prognostic signs, early restoration of eye movements in the horizontal direction and the appearance of induced motor responses to transcranial magnetic stimulation of the motor cortex. There are cases of survival in isolation before the age of 18.

Therapy is aimed at the prevention of pneumonia, urinary tract infections, etc., providing good nutrition, preventing bedsores and performing physical exercises to prevent the development of contractures. Speech therapists can help in establishing contact by using conventional signs when blinking or moving the eyes. Since the cognitive sphere is preserved, the patient is able to make independent decisions on the continuation of treatment.