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Critical illness neuropathy — SCE Neurology MCQ

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ModerateNeuromuscularCritical illness neuropathySCE Neurology

A 48-year-old woman presented with difficulty weaning from ventilation after prolonged sepsis and ICU stay. On examination, there was flaccid limb weakness, reduced reflexes and preserved cognition. Initial investigations showed: NCS showed low motor and sensory amplitudes with axonal pattern. What is the most likely diagnosis?

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Correct answer: A — Critical illness neuropathy

Critical illness neuropathy is the best answer because the vignette describes Critical illness neuropathy: ICU-acquired flaccid axonal weakness suggests critical illness polyneuropathy. Becker muscular dystrophy is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Vasculitic neuropathy and Myotonic dystrophy type 1 are less appropriate because they would require different localisation, timing or test findings; Motor neurone disease would fit a different syndrome. Clinical pearl: GBS is possible but preceding sepsis/ICU course and axonal pattern favour this.

Reference: NICE NG42; ABN myasthenia gravis guidance; EAN/PNS GBS-CIDP guidance