Distinctions between critical illness polyneuropathy and axonal Guillain- Barre syndrome

Diagnosis of acute neuropathies

“…Sensation is usually spared though a reduced level of consciousness hampers the clinical examination, and a differential diagnosis of GBS is often considered [41]. Nevertheless, critical illness neuromuscular disease occurs while the patient is in the intensive care unit, whereas most patients with GBS are admitted to the ICU with severe weakness.…”

“…The etiology of the disorder is unclear but its development is related to the extent of organ failure, and the use of corticosteroids and non-depolarizing neuromuscular blocking agents [19,75]. This entity has features that make it distinct from Guillain-Barré syndrome [20,41], though electrophysiological differentiation between the axonal variant of GBS and the axonal degeneration that occurs in criti- On day 1 conduction studies of the radial nerve showed a moderate 75 % reduction of the sensory action potential (SNAP) amplitude at the elbow with normal conduction velocity. At the axilla the SNAP was severely reduced and conduction between elbow and axilla was slowed.…”

Neuromuscular Disorders in Severe Acute Respiratory Syndrome

“…12 However, the observed normal protein levels in the CSF, relative preservation of DTRs as compared with the severity of muscle weakness, and rapid clinical as well as electrophysiologic improvement in these 4 pa-tients do not favor a diagnosis of axonal Guillain-Barré syndrome. 12,13 Some viruses, such as cytomegalovirus and varicella zoster virus, may cause peripheral neuropathy through direct attacks on the nerves. 6 Whether such a mechanism exists in SARS-related neuropathy is unknown.…”

Critical illness polyneuropathy and myopathy: clinical features, risk factors and prognosis

“…Sensory and motor nerve conduction studies, repetitive nerve stimulation and electromyography are the next step in revealing the cause of the neuromuscular weakness. Furthermore, GBS, a treatable inflammatory polyneuropathy, may occur in critically ill patients and electrodiagnostic testing is necessary to differentiate between an axonal or demyelinating neuropathy [8,36]. The presence of a demyelinating neuropathy confirms the diagnosis of GBS and the patients should be treated with immunomodulating therapies.…”