Focal Neuropathy in Children with Critical Illness

Abstract

Four children are described who developed focal lower limb nerve palsies following critical illness. Two had clinical and/or neurophysiological evidence of simultaneous generalised critical illness polyneuropathy. The diagnosis was delayed in three patients due to the presence of central motor abnormalities and slow motor recovery. Follow-up from seven months to three years showed minimal or no recovery. In three, a vasculitic skin infarct, compartment syndrome and focal myositis could have caused nerve compression. We suggest that in critical illness peripheral nerves have an increased susceptibility to damage by local pressure.

Critical illness - focal neuropathy - compression

References

• 1 Bonfanti R, Bognetti E, Meschi F, Megaglini S, D'Angelo A, Chiumello G. Disseminated intravascular coagulation and severe neuropathy complicating ketoacidosis in a newly diagnosed diabetic child.  Acta Diabetol. 1994;  31 173-174
• 2 Davies M S, Nadel S, Habibi P, Levin M, Hunt D M. The orthopaedic management of peripheral ischaemia in meningococcal septicaemia in children.  Br J Bone & Joint Surg. 2000;  82 383-386
• 3 Engber W D, Marti L B, Moore C T. Peripheral neuropathy - an unusual complication of meningococcaemia.  J Hand Surg. 1977;  2 404-405
• 4 Middleton P J, Alexander R M, Szymanski M T. Severe myositis during recovery from influenza.  Lancet. 1970;  2 533-535
• 5 Roig M, Santamaria J, Fernandez E, Colomer J. Peripheral neuropathy in meningococcal septicaemia.  Eur J Neurol. 1985;  24 310-313
• 6 Sheth R D, Bolton C F. Neuromuscular complications of sepsis in children.  J Child Neurol. 1995;  10 346-351
• 7 Sloane A E, Vajsar J, Laxer R M, Babyn P S, Murphy E G. Spontaneous non-traumatic anterior compartment syndrome with peroneal neuropathy and favourable outcome.  Neuropediatrics. 1994;  25 268-270
• 8 Wiis J, Qvist J. Peroneusparese efter langvarigt sengeleje hos intensivpatienter. [Peroneal nerve palsy in intensive care patients undergoing long term bedrest].  Ugeskr Laeger. 1999;  161 4641-4642
• 9 Wijdicks E F, Litchy W J, Harrison B A, Gracey D R. The clinical spectrum of critical illness polyneuropathy.  Mayo Clin Proc. 1994;  69 955-959
• 10 Zochodne D W, Bolton C F, Wells G A, Gilbert J J, Hahn A F, Brown J D. et al . Critical illness polyneuropathy. A complication of sepsis and multiorgan failure.  Brain. 1987;  110 819-841