20. Neurological Complications of Medical Illness: Critical Illness Neuropathy and Myopathy

  1. Edward M. Manno MD, FCCM, FAAN, FAHA
  1. Edward M. Manno Manno MD, FCCM, FAAN, FAHA

Published Online: 11 APR 2012

DOI: 10.1002/9781118297162.ch20

Emergency Management in Neurocritical Care

Emergency Management in Neurocritical Care

How to Cite

Manno Manno, E. M. (2012) Neurological Complications of Medical Illness: Critical Illness Neuropathy and Myopathy, in Emergency Management in Neurocritical Care (ed E. M. Manno), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781118297162.ch20

Editor Information

  1. Neurological Intensive Care Unit Cleveland Clinic Cleveland, OH, USA

Author Information

  1. Neurological Intensive Care Unit Cleveland Clinic Cleveland, OH, USA

Publication History

  1. Published Online: 11 APR 2012
  2. Published Print: 11 MAY 2012

Book Series:

  1. Neurology in Practice

Book Series Editors:

  1. Robert A. Gross and
  2. Jonathan W. Mink

Series Editor Information

  1. Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA

ISBN Information

Print ISBN: 9780470654736

Online ISBN: 9781118297162

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Keywords:

  • Critical illness neuropathy;
  • Critical illness myopathy;
  • Critical illness neuromyopathy;
  • complications of sepsis;
  • neuromuscular complications of sepsis;
  • intensive care neuropathy;
  • intensive care myopathy;
  • axonal loss in critically ill patients

Summary

Critical illness neuropathy and myopathy have been commonly recognized phenomena for centuries. Patients will present will a diffuse flaccid weakness. The process appears to be mediated through inflammatory cytokines and interleukins released during sepsis. These inflammatory mediators are speculated to increase endoneural edema and affect nerve and muscle bioenergetics. The resultant decrease in nerve and muscle energy production leads to axonal loss and a functional “dying back” neuropathy. Muscle can also be directly affected. Toxic mediators affect the metabolism of myosin protein producing a characteristic myosin loss myopathy. Treatment consists of early recognition and treatment of sepsis and limitation of neuromuscular blockade. Prognosis is related to the severity and duration of sepsis. Tight glucose control and early mobilization may facilitate rehabilitation.