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Critical illness neuropathy

Starane Shepherd, Ayush Batra, David P Lerner
Critical illness myopathy (CIM) and neuropathy are underdiagnosed conditions within the intensive care setting and contribute to prolonged mechanical ventilation and ventilator wean failure and ultimately lead to significant morbidity and mortality. These conditions are often further subdivided into CIM, critical illness polyneuropathy (CIP), or the combination-critical illness polyneuromyopathy (CIPNM). In this review, we discuss the epidemiology and pathophysiology of CIM, CIP, and CIPNM, along with diagnostic considerations such as detailed clinical examination, electrophysiological studies, and histopathological review of muscle biopsy specimens...
January 2017: Neurohospitalist
Clarissa Crone
INTRODUCTION: Critically ill patients often develop tetraparesis. It has been debated whether this is caused by neuropathy, myopathy, or both. The aim was to determine the incidence of myopathy and neuropathy in weak patients in the intensive care unit by performing several electrophysiological examinations, including quantitative EMG. METHODS: Forty-nine patients referred for electrophysiological examination because of suspected critical illness-related weakness underwent electromyography (EMG), nerve conduction studies, and direct muscle stimulation...
December 20, 2016: Muscle & Nerve
Yasmine Ali Abdelhamid, Liza Phillips, Michael Horowitz, Adam Deane
BACKGROUND: Many patients who survive the intensive care unit (ICU) experience long-term complications such as peripheral neuropathy and nephropathy which represent a major source of morbidity and affect quality of life adversely. Similar pathophysiological processes occur frequently in ambulant patients with diabetes mellitus who have never been critically ill. Some 25 % of all adult ICU patients have diabetes, and it is plausible that ICU survivors with co-existing diabetes are at heightened risk of sequelae from their critical illness...
2016: Pilot and Feasibility Studies
Tiphaine Bourseau, Flavie Fremondière, Valérie Dubus, Bénédicte Gohier, Dewi Le Gal, Fabien Cave, Isabelle Richard, Nicolas Lerolle
OBJECTIVE: After critical illness, some survivors experience long-term physical, functional, neurocognitive and/or mental health impairments, which has been termed "Post-Intensive Care syndrome" (PICS) [1]. A specific follow-up is required and many specialized follow-up clinics have been created both abroad and in France. The aim of this study is to evaluate long-term outcomes after critical illness, through the International Classification of Functioning, Disability and Health, and to analyse rehabilitation needs after intensive care unit (ICU) discharge...
September 2016: Annals of Physical and Rehabilitation Medicine
Baxter B Allen, James A Charles, Esperanza Papadopoulos, Edward K Avila
No abstract text is available yet for this article.
July 2016: Autonomic Neuroscience: Basic & Clinical
Salil Gupta, Mayank Mishra
BACKGROUND: Critical illness polyneuropathy (CIP) is a common complication of severe sepsis and systemic inflammatory response syndrome (SIRS). The risk factors for sepsis-induced CIP have not been well established. AIM: The aim of this study was to find out the risk factors of sepsis-induced CIP, especially its relationship with the severity of illness. PATIENTS AND METHODS: A cohort of 100 patients with sepsis defined as SIRS of proven or presumed microbial etiology were followed up with nerve conduction studies (NCS) performed within the first 14 days of admission...
July 2016: Neurology India
T H P Draak, K C Gorson, E K Vanhoutte, S I van Nes, P A van Doorn, D R Cornblath, L H van den Berg, C G Faber, I S J Merkies
BACKGROUND AND PURPOSE: There is increasing interest in using patient-reported outcome measures (PROMs) in clinical studies to capture individual changes over time. However, PROMs have also been criticized because they are entirely subjective. Our objective was to examine the relationship between a subjective PROM and an objective outcome tool in patients with Guillain-Barré syndrome (GBS), chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and gammopathy-related polyneuropathy (MGUSP)...
July 2016: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Sarah E Jolley, Aaron E Bunnell, Catherine L Hough
Survivorship after critical illness is an increasingly important health-care concern as ICU use continues to increase while ICU mortality is decreasing. Survivors of critical illness experience marked disability and impairments in physical and cognitive function that persist for years after their initial ICU stay. Newfound impairment is associated with increased health-care costs and use, reductions in health-related quality of life, and prolonged unemployment. Weakness, critical illness neuropathy and/or myopathy, and muscle atrophy are common in patients who are critically ill, with up to 80% of patients admitted to the ICU developing some form of neuromuscular dysfunction...
November 2016: Chest
Clara-Maria Schutte, Cornelius H van der Meyden, Linette van Niekerk, Mandisa Kakaza, Riaan van Coller, Veronica Ueckermann, Nicky M Oosthuizen
The hepatic porphyrias are a group of rare metabolic disorders, each of which is associated with a specific enzymatic alteration in the haem biosynthesis pathway. In South Africa (SA), a high incidence of variegate porphyria (VP) is seen as a result of a founder effect, but acute intermittent porphyria (AIP) is also encountered. The development of acute neurovisceral attacks is related to environmental factors, including medications, hormones and diet. A possible manifestation of a severe attack is rapidly progressing quadriparesis, which may mimic Guillain-Barré syndrome...
January 2016: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
Nan Li, Zhongmin Liu, Guang Wang, Shiji Wang
AIMS: Sepsis patients and other patients in the critical care settings are at very high risk of mortality due to the primary illness. However, a fraction of patients, even after showing initial clinical improvement, deteriorates relentlessly at later stages. Increasingly, it is being identified that this is mostly due to dysfunction of the neurological system. MAIN METHODS: We obtained peripheral nerve biopsies from the sural nerve from ICU patients. Nav1.6 expression was significantly diminished...
December 15, 2015: Life Sciences
Aida Field-Ridley, Madan Dharmar, David Steinhorn, Craig McDonald, James P Marcin
OBJECTIVE: ICU-acquired weakness, comprised critical illness myopathy and critical illness neuropathy, occurs in a significant proportion of critically ill adults and is associated with high morbidity and mortality. Little is known about ICU-acquired weakness among critically ill children. We investigated the incidence of ICU-acquired weakness among PICUs participating in the Virtual PICU Systems database. We also sought to identify associated risk factors for ICU-acquired weakness and evaluate the hypothesis that ICU-acquired weakness is associated with poor clinical outcomes...
January 2016: Pediatric Critical Care Medicine
Armando Gavazzi, Francesca de Rino, Maria Claudia Boveri, Anna Picozzi, Massimo Franceschi
We evaluated 374 consecutive patients from May 2013 to April 2014 who underwent major cardiac surgery. Each patient had an interview and a neurological clinical examination during the rehabilitation period. Patients with possible peripheral nervous system (PNS) complications underwent further electrodiagnostic tests. Among 374 patients undergoing major heart surgery (coronary artery bypass grafting, valvular heart surgery, ascending aortic aneurysm repair) 23 (6.1 %) developed 34 new PNS complications. We found four brachial plexopathies; four carpal tunnel syndromes; five critical illness neuropathies; three worsening of pre-existing neuropathies; two involvement of X, one of IX and one of XII cranial nerves; three peroneal (at knee), one saphenous, two median (at Struthers ligament), six ulnar (at elbow) mononeuropathies; two meralgia parestheticas...
February 2016: Neurological Sciences
Kuang-Hsi Chang, Yi-Chao Hsu, Mei-Yin Chang, Cheng-Li Lin, Trong-Neng Wu, Bing-Fang Hwang, Chiu-Ying Chen, Hui-Chuan Liu, Chia-Hung Kao
Peripheral neuropathy and inflammatory reactions of the central nervous system may accompany rheumatoid arthritis (RA). Inflammatory processes play a critical role in epilepsy. Therefore, we conducted this study to determine the risk of epilepsy in patients with RA.The RA cohort comprised patients ages 20 years and older who were newly diagnosed with RA between 2000 and 2011, with data obtained from the Registry of Catastrophic Illnesses Patient Database. Patients without RA were frequency matched with an RA cohort at a 1:1 ratio according to age, sex, and year of RA diagnosis...
September 2015: Medicine (Baltimore)
L E M Haas, R S van der Ploeg, J J Quak, J P J Burgmans, M Otten
A young man had severe septic shock with multiorgan failure due to necrotizing fasciitis caused by group A streptococcus after endoscopic repair of a preperitoneal inguinal hernia. He was treated with surgical exploration and antibiotics and resuscitated with fluids, vasopressors, and inotropic agents. He survived this critical illness, but when he woke up from sedation, his vision was lost in both eyes. Ophthalmological evaluation revealed minimal peripapillary retinal hemorrhages without signs of papillary edema...
September 2015: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
Luan Nguyen The, Cong Nguyen Huu
INTRODUCTION: Critical illness polyneuropathy, myopathy and polyneuromyopathy, grouped under the term CIP/CIM, share several risk factors and are associated with debilitating outcomes. OBJECTIVE: To assess the incidence and distribution of CIP/CIM subtypes and evaluate the risk factors and outcomes of CIP/CIM in a rural hospital in Vietnam. METHOD: One hundred and thirty three critically ill patients treated more than ten days in the ICU were enrolled...
October 15, 2015: Journal of the Neurological Sciences
Greet Hermans, Greet Van den Berghe
A substantial number of patients admitted to the ICU because of an acute illness, complicated surgery, severe trauma, or burn injury will develop a de novo form of muscle weakness during the ICU stay that is referred to as "intensive care unit acquired weakness" (ICUAW). This ICUAW evoked by critical illness can be due to axonal neuropathy, primary myopathy, or both. Underlying pathophysiological mechanisms comprise microvascular, electrical, metabolic, and bioenergetic alterations, interacting in a complex way and culminating in loss of muscle strength and/or muscle atrophy...
August 5, 2015: Critical Care: the Official Journal of the Critical Care Forum
J Mehrholz, M Pohl, J Kugler, J Burridge, S Mückel, B Elsner
Intensive care unit (ICU) acquired or generalised weakness due to critical illness myopathy (CIM) and polyneuropathy (CIP) are major causes of chronically impaired motor function that can affect activities of daily living and quality of life. Physical rehabilitation of those affected might help to improve activities of daily living. Our primary objective was to assess the effects of physical rehabilitation therapies and interventions for people with CIP and CIM in improving activities of daily living such as walking, bathing, dressing and eating...
October 2015: European Journal of Physical and Rehabilitation Medicine
O Friedrich, M B Reid, G Van den Berghe, I Vanhorebeek, G Hermans, M M Rich, L Larsson
Critical illness polyneuropathies (CIP) and myopathies (CIM) are common complications of critical illness. Several weakness syndromes are summarized under the term intensive care unit-acquired weakness (ICUAW). We propose a classification of different ICUAW forms (CIM, CIP, sepsis-induced, steroid-denervation myopathy) and pathophysiological mechanisms from clinical and animal model data. Triggers include sepsis, mechanical ventilation, muscle unloading, steroid treatment, or denervation. Some ICUAW forms require stringent diagnostic features; CIM is marked by membrane hypoexcitability, severe atrophy, preferential myosin loss, ultrastructural alterations, and inadequate autophagy activation while myopathies in pure sepsis do not reproduce marked myosin loss...
July 2015: Physiological Reviews
Thomas Zambelis, Dimitra Giotopoulou, Theodoros Soldatos, Evangelos Anagnostou, Michael Rentzos
No abstract text is available yet for this article.
September 2015: Neurological Sciences
Volkan Solmaz, Dürdane Aksoy, Mustafa Yılmaz, Enes Eser, Oytun Erbas
OBJECTIVES: Critical illness neuropathy (CIN) is a condition that may occur in diseases with severe systemic response, particularly in sepsis. The aim of this study is to investigate the potential anti-inflammatory and lipid-peroxidation inhibiting activities of lacosamide by measuring tumour necrotizing factor-alpha (TNF-alpha), C-reactive protein (CRP), malondialdehyde (MDA) and white blood cells (WBC) using electroneuromyography (ENMG) in rats with sepsis-induced critical illness neuropathy (SICIN)...
September 2015: Neurological Research
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