Critical illness polyneuropathy and myopathy 20 years later. No man’s land? No, it is our land!

Excerpt

In 1991, I was intrigued by a comatose head trauma patient who, after the resolution of severe intracranial hypertension and interruption of deep sedation, remained profoundly weak with virtually no movement of the limbs in response to painful stimulation. Motor response, which was localizing at ICU admission, had deteriorated after the onset of pneumonia and Staphylococcus aureus bacteremia. Deep tendon reflexes, expected to be increased, were instead absent. Intact brainstem reflexes, and eye opening and grimacing in response to pain suggested that brain injury was improving. Prognosis was predicted to be dire. Several investigations were performed including brain computed tomography (CT), spinal magnetic resonance imaging (MRI), and lumbar puncture but only the electromyography (EMG) clarified the diagnosis by showing features compatible with critical illness polyneuropathy (CIP). The patient eventually regained consciousness and full muscle strength with only moderate cognitive disability several months after ICU discharge. I have asked myself many times what the outcome of this patient would have been had we relied only on motor response to pain to assess prognosis. In fact, neurological examination remains a mainstay of clinical practice in the ICU [1]. …