Neuromuscular disorders in medical and surgical ICUs: case studies in critical care neurology

Screening Power of Short Tau Inversion Recovery Muscle Magnetic Resonance Imaging in Critical Illness Myo-neuropathy and Guillain–Barre Syndrome in the Intensive Care Unit

Introduction

Critical illness myoneuropathy (CIMN) or intensive care unit (ICU)-acquired weakness (AW) is a common cause of weakness in ICU patients. Guillain–Barre syndrome (GBS) is also a common cause of acute neurological weakness in the ICU. It is diagnosed by clinical features, nerve conduction studies (NCS), and muscle/nerve biopsies.

Methods

The short tau inversion recovery (STIR) muscle magnetic resonance (MR) images of seven patients with suspected CIMN and seven GBS patients over a 5-year period from February 2015 till May 2020 were analyzed.

Results

All seven patients with CIMN showed diffuse muscle edema, predominating in the lower limbs. Only one patient with GBS showed abnormal magnetic resonance imaging (MRI) changes (14%) and MRI was normal in 86%. The sensitivity of MRI to detect CIMN was 100%, whereas the specificity was 85.7%. Thus, the positive predictive value (PPV) of MRI in this situation was 87.5% and the negative predictive value (NPV) was 100%.

Conclusion

Muscle STIR imaging may help to differentiate between CIMN and GBS.

How to cite this article

Maramattom BV. Screening Power of Short Tau Inversion Recovery Muscle Magnetic Resonance Imaging in Critical Illness Myoneuropathy and Guillain–Barre Syndrome in the Intensive Care Unit. Indian J Crit Care Med 2022;26(2):204–209.

Intensive care unit-acquired weakness

When critically ill, a severe weakness of the limbs and respiratory muscles often develops with a prolonged stay in the intensive care unit (ICU), a condition vaguely termed intensive care unit-acquired weakness (ICUAW). Many of these patients have serious nerve and muscle injury. This syndrome is most often seen in surviving critically ill patients with sepsis or extensive inflammatory response which results in increased duration of mechanical ventilation and hospital length of stay. Patients with ICUAW often do not fully recover and the disability will seriously impact on their quality of life. In this chapter we discuss the current knowledge on the pathophysiology and risk factors of ICUAW. Tools to diagnose ICUAW, how to separate ICUAW from other disorders, and which possible treatment strategies can be employed are also described. ICUAW is finally receiving the attention it deserves and the expectation is that it can be better understood and prevented.