Related Experiment Videos
Critical illness neuropathy in pediatric intensive care patients
B Petersen1, C Schneider, H M Strassburg
1Children's Hospital, University of Wuerzburg, Germany.
Insights
Critical illness neuropathy, an axonal polyneuropathy, is rarely diagnosed in children. This study highlights its potential underdiagnosis in pediatric intensive care, emphasizing early electrophysiologic evaluation.
Area of Science:
- Neurology
- Pediatric Critical Care Medicine
Background:
- Critical illness neuropathy (CIN) is an axonal polyneuropathy commonly seen in adult intensive care unit (ICU) patients with sepsis and multiple organ dysfunction.
- Diagnosis of CIN in pediatric populations is infrequent, despite its potential impact on critically ill children.
Observation:
- Two pediatric cases of CIN were observed within one year.
- Both patients, aged 6.5 and 2.5 years, experienced prolonged mechanical ventilation and developed sepsis with multiple organ dysfunction following severe neurological conditions (brain contusion, Crouzon's disease surgery).
Findings:
- Following sepsis treatment, both children developed flaccid tetraparesis.
- Standard laboratory tests and MRI were normal, but electrophysiologic studies confirmed axonal polyneuropathy.
- Patients showed spontaneous improvement over several months.
Implications:
- CIN may be underdiagnosed in critically ill children.
- Neurologic examination and early electrophysiologic testing are crucial for diagnosing CIN in pediatric ICU patients.
- Understanding CIN is vital for managing acquired lower motor neuron weakness in pediatric critical care.
Abstract:
Critical illness neuropathy is an axonal polyneuropathy recognized more frequently in adult intensive care patients with sepsis and multiple organ dysfunction. In children the diagnosis is rarely made. Within 1 year the authors observed two children with critical illness neuropathy. Both patients, a male 6 years, 6 months of age with a brain contusion and a male 2 years, 6 months of age who underwent craniectomy for Crouzon's disease, required prolonged mechanical ventilation and developed sepsis with multiple organ dysfunction. Three to 4 weeks after successful treatment of the sepsis, a flaccid tetraparesis was noticed in both patients. Laboratory investigations of blood and cerebrospinal fluid and spinal magnetic resonance imaging revealed normal results. Electrophysiologic examinations were indicative of an axonal polyneuropathy. Spontaneous improvement occurred within several months. It is likely that critical illness neuropathy occurs more often in critically ill children than previously thought. Careful neurologic examination and early electrophysiologic investigations are necessary to establish the diagnosis. Important differential diagnoses of acquired lower motor neuron weakness in pediatric intensive care medicine are discussed.