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Critical Care Clinics Jan 2023Diseases of the peripheral nervous system create an additional diagnostic conundrum within the intensive care setting. Causes are vast, presentations are myriad, and... (Review)
Review
Diseases of the peripheral nervous system create an additional diagnostic conundrum within the intensive care setting. Causes are vast, presentations are myriad, and symptoms are often ill-defined or misidentified. Care benefits from a multidisciplinary approach including a neuromuscular specialist, rehabilitation services, and a specialty pharmacist in addition to the neurocritical care team. In general, survivors achieve a good functional recovery relative to their preintensive care unit baseline.
Topics: Humans; Neuromuscular Diseases; Critical Care; Muscle Weakness; Intensive Care Units; Critical Illness
PubMed: 36333027
DOI: 10.1016/j.ccc.2022.06.004 -
Emergency Medicine Clinics of North... Feb 2021Weakness has a broad differential diagnosis. A paradigm for organizing possibilities is to consider what part of the nervous system is involved, ranging from brain,... (Review)
Review
Weakness has a broad differential diagnosis. A paradigm for organizing possibilities is to consider what part of the nervous system is involved, ranging from brain, spinal cord, nerve roots, and peripheral nerves to the neuromuscular junction. The clinician can consider internal versus external causes. Some neurologic conditions have subtle presentations yet carry a risk of short-term decompensation if not recognized. It is helpful to consider whether an emergency department presentation of weakness is a new disease process or represents an exacerbation of an established condition. Emergency presentations of weakness are challenging, and one must carefully consider potential serious causes.
Topics: Acute Disease; Diagnosis, Differential; Emergency Service, Hospital; Humans; Muscle Weakness
PubMed: 33218656
DOI: 10.1016/j.emc.2020.09.010 -
Current Opinion in Critical Care Feb 2020Diaphragm weakness can impact survival and increases comorbidities in ventilated patients. Mechanical ventilation is linked to diaphragm dysfunction through several... (Review)
Review
PURPOSE OF REVIEW
Diaphragm weakness can impact survival and increases comorbidities in ventilated patients. Mechanical ventilation is linked to diaphragm dysfunction through several mechanisms of injury, referred to as myotrauma. By monitoring diaphragm activity and titrating ventilator settings, the critical care clinician can have a direct impact on diaphragm injury.
RECENT FINDINGS
Both the absence of diaphragm activity and excessive inspiratory effort can result in diaphragm muscle weakness, and recent evidence demonstrates that a moderate level of diaphragm activity during mechanical ventilation improves ICU outcome. This supports the hypothesis that by avoiding ventilator overassistance and underassistance, the clinician can implement a diaphragm-protective ventilation strategy. Furthermore, eccentric diaphragm contractions and end-expiratory shortening could impact diaphragm strength as well. This review describes these potential targets for diaphragm protective ventilation.
SUMMARY
A ventilator strategy that results in appropriate levels of diaphragm activity has the potential to be diaphragm-protective and improve clinical outcome. Monitoring respiratory effort during mechanical ventilation is becoming increasingly important.
Topics: Diaphragm; Humans; Muscle Weakness; Respiration; Respiration, Artificial; Ventilators, Mechanical
PubMed: 31738233
DOI: 10.1097/MCC.0000000000000683 -
Practical Neurology Dec 2022A man in his 20s gave a 9-year history of recurrent muscle pain and weakness, occurring mostly after exercise, and lasting for up to 2 days. There had been one episode...
A man in his 20s gave a 9-year history of recurrent muscle pain and weakness, occurring mostly after exercise, and lasting for up to 2 days. There had been one episode of severe rhabdomyolysis after cold exposure. He also had longstanding hypokalaemia, which was key to his correct diagnosis but was not followed. This case highlights the importance of an appropriately methodical investigation of weak hypokalaemic patients, and the relevance of hypokalaemia as a cause of neuromuscular symptoms not related to muscular channelopathies.
Topics: Male; Humans; Hypokalemia; Muscle Weakness; Rhabdomyolysis; Paresis
PubMed: 35907633
DOI: 10.1136/pn-2022-003433 -
Handbook of Clinical Neurology 2023Weakness of limb and respiratory muscles that occurs in the course of critical illness has become an increasingly common and serious complication of adult and pediatric... (Review)
Review
Weakness of limb and respiratory muscles that occurs in the course of critical illness has become an increasingly common and serious complication of adult and pediatric intensive care unit patients and a cause of prolonged ventilatory support, morbidity, and prolonged hospitalization. Two motor disorders that occur singly or together, namely critical illness polyneuropathy and critical illness myopathy, cause weakness of limb and of breathing muscles, making it difficult to be weaned from ventilatory support, commencing rehabilitation, and extending the length of stay in the intensive care unit, with higher rates of morbidity and mortality. Recovery can take weeks or months and in severe cases, and may be incomplete or absent. Recent findings suggest an improved prognosis of critical illness myopathy compared to polyneuropathy. Prevention and treatment are therefore very important. Its management requires an integrated team approach commencing with neurologic consultation, creatine kinase (CK) measurement, detailed electrodiagnostic, respiratory and neuroimaging studies, and potentially muscle biopsy to elucidate the etiopathogenesis of the weakness in the peripheral and/or central nervous system, for which there may be a variety of causes. These tenets of care are being applied to new cases and survivors of the coronavirus-2 disease pandemic of 2019. This chapter provides an update to the understanding and approach to critical illness motor disorders.
Topics: Adult; Child; Humans; Motor Disorders; Critical Illness; COVID-19; Muscular Diseases; Polyneuropathies; Intensive Care Units; Muscle Weakness
PubMed: 37562893
DOI: 10.1016/B978-0-323-98818-6.00031-5 -
Arquivos de Neuro-psiquiatria Apr 2017Acute muscle weakness in children is a pediatric emergency. During the diagnostic approach, it is crucial to obtain a detailed case history, including: onset of... (Review)
Review
Acute muscle weakness in children is a pediatric emergency. During the diagnostic approach, it is crucial to obtain a detailed case history, including: onset of weakness, history of associated febrile states, ingestion of toxic substances/toxins, immunizations, and family history. Neurological examination must be meticulous as well. In this review, we describe the most common diseases related to acute muscle weakness, grouped into the site of origin (from the upper motor neuron to the motor unit). Early detection of hyperCKemia may lead to a myositis diagnosis, and hypokalemia points to the diagnosis of periodic paralysis. Ophthalmoparesis, ptosis and bulbar signs are suggestive of myasthenia gravis or botulism. Distal weakness and hyporeflexia are clinical features of Guillain-Barré syndrome, the most frequent cause of acute muscle weakness. If all studies are normal, a psychogenic cause should be considered. Finding the etiology of acute muscle weakness is essential to execute treatment in a timely manner, improving the prognosis of affected children.
Topics: Acute Disease; Child; Humans; Muscle Weakness
PubMed: 28489146
DOI: 10.1590/0004-282X20170026 -
Emergency Medicine Clinics of North... Nov 2016Weakness is a common complaint in the emergency department, and a most challenging one, because before the emergency physician can proceed with an evaluation, the... (Review)
Review
Weakness is a common complaint in the emergency department, and a most challenging one, because before the emergency physician can proceed with an evaluation, the complaint of weakness must be fully clarified to determine about what the patient is actually complaining. This article will focus on causes of acute generalized nontraumatic bilateral weakness. Evaluation begins with the history and physical examination, followed by diagnostic testing in some cases.
Topics: Acute Disease; Diagnosis, Differential; Emergency Service, Hospital; Humans; Muscle Weakness; Physical Examination
PubMed: 27741989
DOI: 10.1016/j.emc.2016.06.006 -
Zhurnal Nevrologii I Psikhiatrii Imeni... 2023Guillain-Barré syndrome (GBS) is an immune-mediated disease of the peripheral nervous system that can occur in both children and adults. The classic presentation of GBS... (Review)
Review
Guillain-Barré syndrome (GBS) is an immune-mediated disease of the peripheral nervous system that can occur in both children and adults. The classic presentation of GBS is characterized by progressive symmetrical, ascending muscle weakness. Patients with GBS require meticulous monitoring due to the risk of bulbar syndrome, respiratory failure and autonomic dysfunction, which can be life-threatening. Early diagnosis and timely prescription of pathogenetic therapy for GBS are particularly important, especially in young children. Meanwhile, the spectrum of disorders covered by GBS has expanded significantly; its eponym is now designate any variant of acute dysimmune polyneuropathy, and its atypical forms pose a serious diagnostic problem for clinicians. This review article provides an analysis of the data available in the medical literature on GBS in children and discusses the tactics for diagnosing and managing patients with GBS, taking into account the Russian and European clinical recommendations.
Topics: Adult; Humans; Child; Child, Preschool; Guillain-Barre Syndrome; Muscle Weakness; Autonomic Nervous System Diseases; Paresis; Russia
PubMed: 37942969
DOI: 10.17116/jnevro202312309220 -
Clinics in Chest Medicine Jun 2019Respiratory muscle weakness is relatively rare in clinical practice; therefore, it is seldom a clinician's first thought. However, it should always be considered where a... (Review)
Review
Respiratory muscle weakness is relatively rare in clinical practice; therefore, it is seldom a clinician's first thought. However, it should always be considered where a patient has unexplained breathlessness, respiratory failure, or experiences difficulty weaning from mechanical ventilation. Diaphragm weakness can often be ruled out by careful application of history, examination, and noninvasive bedside tests, although more quantitative tests exist. Where the predominant problem is respiratory muscle weakness, these tests convey useful prognostic information, which can be used for the management of an individual patient and to enrich study populations allowing reduced sample size in clinical trials.
Topics: Humans; Muscle Weakness; Physical Examination; Respiratory Muscles
PubMed: 31078211
DOI: 10.1016/j.ccm.2019.02.015 -
Handbook of Clinical Neurology 2016Functional (psychogenic) limb weakness describes genuinely experienced limb power or paralysis in the absence of neurologic disease. The hallmark of functional limb... (Review)
Review
Functional (psychogenic) limb weakness describes genuinely experienced limb power or paralysis in the absence of neurologic disease. The hallmark of functional limb weakness is the presence of internal inconsistency revealing a pattern of symptoms governed by abnormally focused attention. In this chapter we review the history and epidemiology of this clinical presentation as well as its subjective experience highlighting the detailed descriptions of authors at the end of the 19th and early 20th century. We discuss the relevance that physiological triggers such as injury and migraine and psychophysiological events such as panic and dissociation have to understanding of mechanism and treatment. We review many different positive diagnostic features, their basis in neurophysiological testing and present data on sensitivity and specificity. Diagnostic bedside tests with the most evidence are Hoover's sign, the hip abductor sign, drift without pronation, dragging gait, give way weakness and co-contraction.
Topics: Conversion Disorder; History, 15th Century; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; History, Medieval; Humans; Muscle Weakness; Nervous System Diseases; Paralysis
PubMed: 27719840
DOI: 10.1016/B978-0-12-801772-2.00018-7