Cloister syndrome: types, causes and treatment

Imagine living trapped in a totally soundproof prison, from where you get all the information from the outside but without your voice or actions being seen through the walls. You cannot do anything or talk to anyone or interact with the environment. The world knows you exist, but other than that, you can hardly know what you are feeling, feeling, or thinking.

Now imagine that this prison is nothing but your own body. This is what happens to people who they suffer from the so-called cloister syndrome, A medical condition so disturbing that there is already at least one film that the plot revolves around it: The diving and the butterfly.

    The cloister syndrome

    A neurological syndrome in which the subject is unable to exercise motor activity while maintaining consciousness is called cloister syndrome. The person is able to perceive the environment normally and is conscious, but cannot participate or respond to the stimulation. Usually, the only exception to this is movement of the eyes and possibly the upper eyelid, Which are kept.

    People who suffer from this syndrome almost completely retain their cognitive functions, being the only motor impairment. Although their muscles have the ability to move, motor commands do not reach them. The same goes for the voice.

    The subject is quadriplegic, completely paralyzed, And may lose the ability to breathe on its own. Due to the symptoms (the subject is conscious but cannot move anything except the eyes, and this is not the case in all cases), it is very common for extreme panic, anxiety, depression and lability emotional occur.

    Usually this syndrome occurs in two phases: in the first, the articulatory ability, movement is lost and it is possible that consciousness and basic physiological abilities are lost, but in the chronic phase consciousness, eye movement and breathing capacity is restored.

    The cloister syndrome it can be confused very easily with a coma, Or even with brain death, due to the lack of noticeable motor reaction (if a total cloister is given, there may be no possibility of moving the eyes). In some cases, it has even taken years to identify the patient as aware of what is going on around them.

      Types according to the level of paralysis

      It is possible to do a classification of types of cloister syndrome, Depending on the degree of impact and the capacities that have been maintained. They can generally find three types of presentations.

      1.classical cloister

      This is the type of cloister syndrome in which the subject he cannot perform any voluntary motor action beyond eye movement, Remain aware of the environment. They can blink and move their eye, but only vertically

      2. Incomplete cloister

      In this case, the level of paralysis is similar although in addition to eye movement, they can even mobilize certain fingers or even parts of the head.

      3.total cloister

      The worst of the three subtypes. In total cloister syndrome, the subject is unable to perform any movement, not even the eyes. The gaze remains paralyzed and motionless. However, the subject remains aware of what is happening around him.

      Etiology of this syndrome

      Cloister syndrome occurs due to the existence of brain damage, especially in the brainstem. The most common is damage to the bulge. The breakdown of nerve fibers in this area is what generates generalized motor paralysis and horizontal gaze control.

      Usually this fiber break it is caused by a stroke or stroke with effects in this area, although it may also appear due to traumatic brain injury or disease or tumor. In some cases, it was caused by overdose.

      Depending on its causes, cloister syndrome can be chronic or transient, being the last of the hypotheses that admits the partial or even complete recovery of the functions of the progressive pathway.

        treatment

        Cloister syndrome has no treatment or therapy to cure it. In some cases, if the cause of cloister syndrome is transient or can be recovered improvements may occur and the patient can perform certain movements.

        In most cases, the treatments applied are mainly aimed at keeping the person alive and ensuring that they can breathe and eat properly (the latter by tube). Also to be avoided the emergence of complications related to the lack of movement (For example, avoiding ulcers and sores causes them to stay in the same position for a long time, monitoring nutrition, injecting drugs that keep blood flowing properly throughout the body and without thrombus formation). Physiotherapy is also used to maintain flexibility in joints and muscle groups.

        Another major goal of treatment is developing and learning methods to enable the patient to communicate with their loved ones, for example by the use of pictograms or by eye movements. In some cases, it is even possible to use ICT as an element of communication thanks to the translation of these eye movements. In cases where the eyes do not have mobility, it is also possible to establish simple communication codes through elements that record brain activity, such as the electroencephalogram.

        Must also take into account feelings of loneliness, incomprehension and panic that these subjects often suffer, with what would be useful advice and possible treatment at the psychological level. Psychoeducation can also be very helpful for them and their families, so it helps generate guidelines that allow them to deal with the situation.

        The overall prognosis for this condition is not positive. Most cases tend to die within the first few months, although sometimes they can live for several years. In some cases, it can regain part of its muscle function. And while this is exceptional, on some occasions, such as in the case of Kate Allatt, a full recovery has been achieved.

        Bibliographical references:

        • Maiese, K. (sf). Cloister syndrome. MSD Manual. Version for professionals.
        • Lara-Reyna, J .; Burgos-Morales, N .; Achim J .; Martínez, D. and Cárdenas, B. (2015). Cloister syndrome. Presentation of a case. Chilean Journal of Neurosurgery, 41.
        • Smith, E. and Delargy, M. (2005). Blocked syndrome. BMJ; 330-406

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