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CRITICAL CARE NEUROPATHY
39 year old man came in a few days ago for history of weakness in all four extremities worse in the left leg proximally. He has a long history of months of being bed bound in hospitals after undergoing many GI procedures/sugeries with many complications requiring more surgeries ICU admissions for months and rehab inpatient for months with little resolution. He has pain, sensory deficits and weakness in limbs. The clinical picture and exam suggested critical care neuropathy. EMG showed no response to stimulation of any of the motor nerves in the legs (no response at all). Interestingly, all the muscles tested (seven in each leg) showed no spontaneous activity whatsoever. There is decreased recruitment in all muscles but normal motor units and a few polyphasic ones. No PW or fibs or fascs! The study was limited to the legs. Can I make this a demyelinating type of neuropathy? Would he be a candidate for IVIg? I may bring him back for upper extremities study. Thoughts?
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