Brainstem Stroke and Increased Anal Tone.

After suffering a brainstem stroke, a 62-year-old man developed locked-in syndrome including loss of horizontal eye movement and increased anal tone. Magnetic resonance imaging (MRI) of the patient revealed a massive stroke in the pons and right cerebellum, which seemed to involve the pontine micturition/defecation center (Barrington's nucleus) and the rostral pontine reticular formation (RPRF). As his increased anal tone was intractable to medical treatment, he required intermittent catheterization with an anal bougie tube. In light of the reported cases, our patient developed increased anal tone presumably due to pontine defecation center and RPRF lesion.