Critical Illness Polyneuromyopathy — SCE Neurology MCQ

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ModeratePeripheral Neuropathy & NeuromuscularCritical Illness PolyneuromyopathySCE Neurology

A 50-year-old man in the ICU with sepsis develops progressive flaccid quadriparesis and difficulty weaning from the ventilator after 2 weeks. Reflexes are reduced. NCS show reduced CMAP amplitudes in multiple nerves with normal sensory studies and preserved conduction velocities. EMG shows denervation. His CK is mildly elevated. What is the diagnosis?

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Correct answer: A — Critical illness polyneuropathy and/or myopathy (CIPNM)

Critical illness polyneuropathy (CIP) and critical illness myopathy (CIM) — often coexisting as CIPNM — are common in ICU patients with sepsis, multi-organ failure, and prolonged mechanical ventilation. CIP presents with axonal motor > sensory polyneuropathy. CIM presents with proximal weakness and elevated CK. Risk factors include: sepsis, SIRS, multi-organ failure, prolonged neuromuscular blocking agents, hyperglycaemia, and corticosteroids. NCS distinguishing features: CIP has reduced CMAPs/SNAPs with normal velocities (axonal); CIM has reduced CMAPs with normal SNAPs and direct muscle stimulation shows myopathic changes. A: GBS is possible but the ICU context with sepsis strongly suggests CIPNM. C: MND has UMN signs. D: MG has fatigable weakness. E: No spinal cord signs.

Reference: EAN CIPNM Guidelines