CRITICAL ILLNESS MYOPATHY IN PATIENTS WITH CENTRAL NERVOUS SYSTEM DISORDERS

Abstract

Background Acute myopathy or neuropathy is a common complication in critically ill patients in intensive care unit. This complication is relatively obvious in patients with primary non-neurological disorder. However, such complication is difficult to notice in patients with primary neurological disorder. The aim of our report is to present four patients with a primary central nervous disease who subsequently developed a secondary peripheral nervous disorder. Patients and The four patients had been admitted to the intensive care unit of the Neurological Demethods partment for the acute cerebral disorder. Additionally in the course of disease they had developed clinical signs of either neuropathy or myopathy. One patient was unable to wean from the ventilator. Electrodiagnostic studies and muscle biopsy were performed. Results Electrodiagnostic studies revealed generalized abnormalities, consistent with both neuropathy and myopathy. The predominant finding in muscle biopsy was a myopathy with moderate to severe myosin filament loss. Conclusions This report brings two messages. The first is that one should be aware of the possibility of critical illness myopathy/neuropathy also in the neurological intensive care unit. As this peripheral neurological complication is superimposed on primary central neurological disorder, it may be more difficult to notice and to diagnose it clinically. The second message is that electrodiagnostic studies, though mandatory in confirming peripheral lesion, often cannot distinguish between myopathy and neuropathy. As myopathy bears substantially favorable prognosis, a muscle biopsy may be recommended in such cases.