ACUTE QUADRIPLEGIA WITH DELAYED-ONSET AND RAPID RECOVERY - CASE-REPORT

The authors describe a patient with severe head injury and sepsis who became acutely quadriplegic 3 days postinjury because of a critical il lness polyneuropathy (CIP) and critical illness myopathy (CIM), which resolved rapidly after treatment of the underlying infection. In only 3 days the patient developed septic shock together with flaccid quadri plegia and absent deep tendon reflexes with no clinical or radiologica l evidence of central nervous system deterioration. Neurophysiological studies showed an acute axonal sensorimotor polyneuropathy, whereas t he clinical course strongly suggested a concurrent myopathy. A severe Staphylococcus epidermidis infection accompanied by bacteremia was tre ated and the patient recovered fully within a few days. Although the c ase described here is unique because of its very early onset and rapid resolution, CIP and CIM are frequent complications of sepsis and mult iple organ failure. The authors suggest that severely head injured pat ients with sepsis should be evaluated for CIP and CIM when presenting with unexplained muscle weakness or paralysis.