Acute quadriplegia with delayed onset and rapid recovery

Abstract

The authors describe a patient with severe head injury and sepsis who became acutely quadriplegic 3 days postinjury because of a critical illness polyneuropathy (CIP) and critical illness myopathy (CIM), which resolved rapidly after treatment of the underlying infection. In only 3 days the patient developed septic shock together with flaccid quadriplegia and absent deep tendon reflexes with no clinical or radiological evidence of central nervous system deterioration. Neurophysiological studies showed an acute axonal sensorimotor polyneuropathy, whereas the clinical course strongly suggested a concurrent myopathy. A severe Staphylococcus epidermidis infection accompanied by bacteremia was treated and the patient recovered fully within a few days. Although the case described here is unique because of its very early onset and rapid resolution, CIP and CIM are frequent complications of sepsis and multiple organ failure. The authors suggest that severely head injured patients with sepsis should be evaluated for CIP and CIM when presenting with unexplained muscle weakness or paralysis.

Respiratory weakness is associated with limb weakness and delayed weaning in critical illness*

“…Satisfactory tolerance of the T-piece trial was followed by extubation, regardless of MIP, MEP, VC, or MRC values. Although weaning is commonly considered successful when there is no need for reconnection to the ventilator within 48 hrs after extubation, other investigations (15) and daily experience have shown that long-term mechanically ventilated patients, especially those with CINM, frequently require reintubation and further MV for Ͼ48 hrs after a first extubation. Therefore, to analyze the contribution of respiratory weakness to delayed weaning, we focused on the duration between awakening and successful extubation defined by absence of reintubation within 15 days after extubation.…”

Sepsis-induced myopathy

“…The severity of peripheral muscle weakness is widely variable and can be profound in some cases, manifesting symptoms of paralysis (16). The most widely used clinical tool to assess peripheral muscle strength at the bedside is the Medical Research Council examination, which incorporates strength testing of three muscle groups in each limb with assignment of scores on a scale of 1 to 5.…”

Critical illness myopathy serum fractions affect membrane excitability and intracellular calcium release in mammalian skeletal muscle

“…These intensive care 'de novo' pathologies can affect up to 80 % of patients intubated for more than two weeks [5][6][7][8][9].They also highly increase the risks for secondary complications such as pneumonia, deep vein thrombosis and pulmonary embolism. It is not clear whether these entities have a common or separate origin.Muscle biopsies from intensively treated patients revealed three morphologically distinct types of critical illness myopathy (CIM): (i) myopathy with unspecific morphological alterations [7,10], (ii) myopathy with selective loss of myosin filaments, i. e. thick-filament myopathy [11][12][13] and (iii) acute necrotizing myopathy of intensive care [14,15].…”