Locked-in syndrome in fulminant demyelinating disease.

MRI showed a marked decrease in the bulk of the tumour from the original excision site, but extensive lateral extension along the floor of the skull base with encasement of the intrapetrous portion of the left internal carotid artery. Digital subtraction angiography with intravenous contrast showed a normal venous phase and the absence of vessel displacement or tumour circulation. Using a posterolateral approach a further resection achieved a good macroscopic clearance apart from leaving some residual tumour in the cavernous sinus. The histology was identical to that of the sample taken during the first operation. Postoperatively there were left sided sixth and seventh cranial nerve palsies together with marked speech and swallowing difficulties. A feeding gastrostomy was required. In spite of radiotherapy this neurological deficit has persisted and the left side of the patient's face has become numb. MRI one year after the second operation has shown extensive tumour recurrence affecting the clivus, extending anteriorly into the nasopharynx and posteriorly into the posterior fossa with compression of the medulla and cerebellum.