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J Neurol Neurosurg Psychiatry. Nov 1984; 47(11): 1223–1231.
PMCID: PMC1028091

Polyneuropathy in critically ill patients.

Abstract

Five patients developed a severe motor and sensory polyneuropathy at the peak of critical illness (sepsis and multiorgan dysfunction complicating a variety of primary illnesses). Difficulties in weaning from the ventilator as the critical illness subsided and the development of flaccid and areflexic limbs were early clinical signs. However, electrophysiological studies, especially needle electrode examination of skeletal muscle, provided the definite evidence of polyneuropathy. The cause is uncertain, but the electrophysiological and morphological features indicate a primary axonal polyneuropathy with sparing of the central nervous system. Nutritional factors may have played a role, since the polyneuropathy improved in all five patients after total parenteral nutrition had been started, including the three patients who later died of unrelated causes. The features allow diagnosis during life, and encourage continued intensive management since recovery from the polyneuropathy may occur.

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Selected References

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  • Bolton CF, Baltzan MA, Baltzan RB. Effects of renal transplantation on uremic neuropathy. A clinical and electrophysiologic study. N Engl J Med. 1971 May 27;284(21):1170–1175. [PubMed]
  • Bolton CF, Sawa GM, Carter K. The effects of temperature on human compound action potentials. J Neurol Neurosurg Psychiatry. 1981 May;44(5):407–413. [PMC free article] [PubMed]
  • Kimura J. F-wave velocity in the central segment of the median and ulnar nerves. A study in normal subjects and in patients with Charcot-Marie-Tooth disease. Neurology. 1974 Jun;24(6):539–546. [PubMed]
  • Davis JN. Phrenic nerve conduction in man. J Neurol Neurosurg Psychiatry. 1967 Oct;30(5):420–426. [PMC free article] [PubMed]
  • Hopewell PC, Murray JF. The adult respiratory distress syndrome. Annu Rev Med. 1976;27:343–356. [PubMed]
  • Flear CT, Bhattacharya SS, Singh CM. Solute and water exchanges between cells and extracellular fluids in health and disturbances after trauma. JPEN J Parenter Enteral Nutr. 1980 Mar-Apr;4(2):98–120. [PubMed]
  • Bolton CF, Gilbert JJ, Girvin JP, Hahn A. Nerve and muscle biopsy: electrophysiology and morphology in polyneuropathy. Neurology. 1979 Mar;29(3):354–362. [PubMed]
  • Andersson T, Sidén A. A clinical study of the Guillain-Barré Syndrome. Acta Neurol Scand. 1982 Sep;66(3):316–327. [PubMed]
  • McLeod JG. Electrophysiological studies in the Guillain-Barré syndrome. Ann Neurol. 1981;9 (Suppl):20–27. [PubMed]
  • Asbury AK, Arnason BG, Adams RD. The inflammatory lesion in idiopathic polyneuritis. Its role in pathogenesis. Medicine (Baltimore) 1969 May;48(3):173–215. [PubMed]
  • Schaumburg HH, Spencer PS. Toxic neuropathies. Neurology. 1979 Apr;29(4):429–431. [PubMed]
  • Beisel WR. Mediators of fever and muscle proteolysis. N Engl J Med. 1983 Mar 10;308(10):586–587. [PubMed]
  • Clowes GH, Jr, George BC, Villee CA, Jr, Saravis CA. Muscle proteolysis induced by a circulating peptide in patients with sepsis or trauma. N Engl J Med. 1983 Mar 10;308(10):545–552. [PubMed]
  • Phillips I. Good antimicrobial prescribing. Aminoglycosides. Lancet. 1982 Aug 7;2(8293):311–314. [PubMed]
  • Sterman AB, Schaumburg HH, Asbury AK. The acute sensory neuronopathy syndrome: a distinct clinical entity. Ann Neurol. 1980 Apr;7(4):354–358. [PubMed]
  • Dastur DK, Manghani DK, Osuntokun BO, Sourander P, Kondo K. Neuromuscular and related changes in malnutrition. A review. J Neurol Sci. 1982 Aug;55(2):207–230. [PubMed]
  • Jeejeebhoy KN, Chu RC, Marliss EB, Greenberg GR, Bruce-Robertson A. Chromium deficiency, glucose intolerance, and neuropathy reversed by chromium supplementation, in a patient receiving long-term total parenteral nutrition. Am J Clin Nutr. 1977 Apr;30(4):531–538. [PubMed]
  • Freund H, Atamian S, Fischer JE. Chromium deficiency during total parenteral nutrition. JAMA. 1979 Feb 2;241(5):496–498. [PubMed]
  • Weintraub ME. Hypophosphatemis mimicking acute Guillanin-Barré-Strohl syndrome. A complication of parenteral hyperalimentation. JAMA. 1976 Mar 8;235(10):1040–1041. [PubMed]
  • Victor M, Adams RD, Collins GH. The Wernicke-Korsakoff syndrome. A clinical and pathological study of 245 patients, 82 with post-mortem examinations. Contemp Neurol Ser. 1971;7:1–206. [PubMed]
  • Harper CG. Sudden, unexpected death and Wernicke's encephalopathy: a complication of prolonged intravenous feeding. Aust N Z J Med. 1980 Apr;10(2):230–235. [PubMed]
  • Ishii N, Nishihara Y. Pellagra among chronic alcoholics: clinical and pathological study of 20 necropsy cases. J Neurol Neurosurg Psychiatry. 1981 Mar;44(3):209–215. [PMC free article] [PubMed]
  • Harding AE, Muller DP, Thomas PK, Willison HJ. Spinocerebellar degeneration secondary to chronic intestinal malabsorption: a vitamin E deficiency syndrome. Ann Neurol. 1982 Nov;12(5):419–424. [PubMed]
  • Feit H, Glasberg M, Ireton C, Rosenberg RN, Thal E. Peripheral neuropathy and starvation after gastric partitioning for morbid obesity. Ann Intern Med. 1982 Apr;96(4):453–455. [PubMed]
  • Larca L, Greenbaum DM. Effectiveness of intensive nutritional regimes in patients who fail to wean from mechanical ventilation. Crit Care Med. 1982 May;10(5):297–300. [PubMed]
  • Driver AG, LeBrun M. Iatrogenic malnutrition in patients receiving ventilatory support. JAMA. 1980 Nov 14;244(19):2195–2196. [PubMed]
  • Covelli HD, Black JW, Olsen MS, Beekman JF. Respiratory failure precipitated by high carbohydrate loads. Ann Intern Med. 1981 Nov;95(5):579–581. [PubMed]
  • Askanazi J, Nordenstrom J, Rosenbaum SH, Elwyn DH, Hyman AI, Carpentier YA, Kinney JM. Nutrition for the patient with respiratory failure: glucose vs. fat. Anesthesiology. 1981 May;54(5):373–377. [PubMed]
  • Roussos C, Macklem PT. The respiratory muscles. N Engl J Med. 1982 Sep 23;307(13):786–797. [PubMed]

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