Locked-in syndrome resulting from cervical spine gunshot wound

A patient sustained a cervical spine gunshot wound resulting in immediate quadriplegia and obstruction of both vertebral arteries. After an 8-hour delay, basilar artery thrombosis occurred and resulted in locked-in syndrome. Bilateral occlusion of the vertebral arteries after penetrating cervical trauma has not been reported previously. The incidence and treatment of traumatic basilar thrombosis and locked-in syndrome is reviewed. Rapid diagnosis of ascending thrombosis and prompt treatment with hyperdynamics and anticoagulation may improve outcome.