Critical Illness Polyneuromyopathy. I. Diagnosis
Bednařík J., Vondráček P., Lukáš Z.1, Dvořák K.1, Moravcová E., Adamová B., Čundrle I.2
Neurologická klinika FN a LF MU, Brno 1Patologicko-anatomický ústav FN a LF MU, Brno 2Anesteziologicko-resuscitační oddělení FN, Brno |
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Summary:
The objective of the prospective study was to analyze electrophysiological abnormalities in critically
ill patients and their correlation with histopathological abnormalities and to test thus the possibility
of electrophysiological differentiationof critical illnes polyneurophathy and myopathy (CIPM). Agroup
of 79 critically ill patients was followed up for one month by clinical and electrophysiological methods.
The investigation was completed by 48 patients. Electrophysiological abnormalities suggesting a newly
developed CIPM were found during the 5th week in 27 patients, in 9 patients they were present already
during the baseline examination during the first week. The dominating electrophysiological abnormalities
(with the exception of one patient) were a reduction of the totalmuscular action potentials(CMAP)
or abnormal spontaneous activity suggesting motor axonopathy or myopathy. In 11 patients with this
abnormality muscle biopsy was performed which proved signs of myogenetic affection in all instances
(in 7 in combination with neurogenetic affection). Reduced CMAP during direct muscle stimulation
was found in 7 patients with histological signs of myopathy. Electrophysiological signs of sensitive
neuropathy were present in 14 patients, only in one patient isolated sensitive neuropathy. The investigation
confirmed the high prevalence of CIMP in critically ill patients (56 %) with a dominating motor
affection of the type of axonal neuropathy and myopathy, usually combined. Electrophysiological
differentiation of both types of affections is not reliable. The most valuable electrophysiological
parameter is the CMAP amplitude which makes early detection and the follow up of the grade and
dynamics of the affection possible.
Key words:
critical illness polyneuropathy, critical illness myopathy, direct muscular stimulation,
electrodiagnosis, muscle biopsy
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