Synonyms:
a.k.a. critical illness polyneuropathy CIP
Diagnosis:
This is a clinical diagnosis supported by electrodiagnostic features
Clinical features:
Severely ill patient >1 week in ICU, acute weakness (distal initially), areflexia, flaccid tetraparesis, atrophy, difficulty weaning from ventilator,
Findings on investigations:
+NCS/EMG:
- EMG/NCS: reduced CMAP amplitude, reduced SNAP amplitude, normal velocities, no conduction block, fibrillations.
NCS:
- Axonal
- CMAP: decreased amplitude, normal conduction velocity
- SNAP: decreased or normal amplitude. Normal Sensory conduction velocity
EMG:
- fibrillation potentials, positive waves
Other tests:
- CSF: normal
Pathology:
Axonal loss
No inflammation in nerves
Treatment:
Prevention: Better glycemic control reduces risk of critical care neuropathy.