The differential diagnosis between disorders of consciousness (DoC), on the one hand, and conditions of severe immobility with aphasia, on the other hand, is extremely difficult. A patient is described whose morphology of brain lesions permitted both kinds of disorder. A battery of functional magnetic resonance imaging (fMRI) examinations was applied indicating that severe DoC was implausible. The following clinical course confirmed this conclusion, resulting in a severe tetraparesis/aphasia, however with clear awareness. The data suggest that fMRI can be very useful in differentiating between severe motor disorders, including a locked-in syndrome, and DoC such as the vegetative state and the minimally conscious state.