Neuromuscular paralysis in the intensive care unit

To determine the features, causes, risk factors and outcome of acquired neuromuscular paralysis in critically ill patients. Retrospective review of all confirmed cases of acquired polyneuropathy and myopathy examined by our Neurology service in the Intensive Care Unit [ICU], at King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia over a period of 5 years. All patients had comprehensive electrophysiological studies and one third had muscle and nerve biopsies. Thirty cases were included, 8 cases of polyneuropathy, 15 cases of myopathy and 7 cases of mixed neuropathy and myopathy. Absent deep tendon reflexes and absent sensory potential on nerve conduction studies were significantly suggestive of neuropathy. The level of creatine phosphokinase was not of great diagnostic value. Most polyneuropathy and myopathy cases had passed through a stormy ICU course with sepsis and multiorgan failure. The use of high doses of steroids was more associated with myopathy. Seven patients died in ICU, the others were discharged to the wards after a mean ventilation period of 40 days. One patient became chronic ventilator dependent. From this series and available literature, it seems that symptomatic myopathy is more frequent than polyneuropathy and some risk factors are common for both [sepsis and multiorgan failure] while the use of steroids is more associated with ICU myopathy. Treating sepsis and stopping corticosteroids results in the improvement of most of the cases

fatal complication of bronchiectasis. brain abscess with intraventricular rupture

The classic clinical manifestations of bronchiectasis are cough and daily production of purulent sputum for months to years. The most common complications are hemoptysis and respiratory failure. Brain abscess has become rare in the recent antibiotic era. In this report, we present a case of bronchiectasis complicated by brain abscesses. Despite the early diagnosis and appropriate management, and while the condition of the patient was improving, an intraventricular abscess rupture led to rapid coma then death. Presentation and management of this potentially fatal complication of bronchiectasis are discussed