Near-Death Experiences in patients with locked-in syndrome: Not always a blissful journey

•Retrospective characterization of Near-Death Experiences in locked-in syndrome.•Near-Death Experiences in locked-in syndrome are reported as less positive.•Possible interaction of the infratentorial brain lesions and reported phenomenology.

Memories of Near-Death Experiences (NDEs) most often are recounted as emotionally positive events. At present, no satisfactory explanatory model exists to fully account for the rich phenomenology of NDEs following a severe acute brain injury. The particular population of patients with locked-in syndrome (LIS) provides a unique opportunity to study NDEs following infratentorial brain lesions. We here retrospectively characterized the content of NDEs in 8 patients with LIS caused by an acute brainstem lesion (i.e., “LIS NDEs”) and 23 NDE experiencers after coma with supratentorial lesions (i.e., “classical NDEs”). Compared to “classical NDEs”, “LIS NDEs” less frequently experienced a feeling of peacefulness or well-being. It could be hypothesized that NDEs containing less positive emotions might have a specific neuroanatomical substrate related to impaired pontine/paralimbic connectivity or alternatively might be related to the emotional distress caused by the presence of conscious awareness in a paralyzed body.