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Icu Emg

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neglect

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Two years ago this 75 year old man experienced a poorly defined illness that left him using a cane. His doctor told he had the flu, but the cane never left, despite him getting better. Within two years he was nearly normal, walking with a cane for safety.

He got a pneumonia, clearly seen on chest XR, and was sent to the ICU because of worsening airway. Intubated. Fails to wean within the day. When I was initially consulted I was ho hum, another critical care case of neuropathy/myopathy, and he's got no reflexes, 4/5 all, MS nl.

All nerves studied are low amplitude with greater than 20% slowing in forearm segments of the median and ulnar motor. SNAPs are slowed into the 30s. No sural, low amplitude on LE motors. EMG shows huge MUs, all chronic reorganization and no spont. activity.

How would you put this case together? Then I'll tell you how I did.
 

neglect

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OK. So I think this guy had GBS two years ago, has persistent slowing since then, and then got a pneumonia, got clinically worse. This was not critical care neuropathy/myopathy.
 

PMR 4 MSK

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Sorry no one replied. I wonder if we were all a little too chicken to speak up. I think you are absolutely correct. Good case!
 
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