De Letter et al describe the clinical diagnosis of critical illness polyneuropathy and myopathy (CIPNM) for patients in the Intensive Care Unit (ICU) . The authors are from three hospitals in the Netherlands.
NOTE: The clinical examination for determining muscle and tendon status are described in the previous section.
Exclusion criteria: Neuromuscular blocking agents within past 3 days.
Criteria - both of the following:
(1) both clinical findings on 2 or more consecutive assessments
(2) electrophysiologic evidence of axonal polyneuropathy
Clinical Finding |
Cooperative Patient |
Uncooperative Patient |
motor sumscore |
0 - 25 (< 26; out of 30) |
0 - 7 (< 8; out of 10) |
tendon reflexes |
decreased or absent |
decreased or absent |
Electrophysiologic findings:
(1) findings in ulnar nerve
(1a) distal compound muscle action potential (CMAP) absent or < 4.2 mV
(1b) no evidence of entrapment at the elbow
(1c) no evidence of demyelination (ratio of proximal CMAP area to distal CMAP area > 0.89)
(2) findings in peroneal nerve
(2a) distal compound muscle action potential (CMAP) absent or < 2.6 mV
(2b) no evidence of entrapment at the fibular head
(2c) no evidence of demyelination (ratio of proximal CMAP area to distal CMAP area > 0.89)
(3) spontaneous activity at rest (fibrillations and/or positive waves) in >= 2 examined muscles
Electrophysiologic criteria: 2 or more of the findings present (1 and 2, 1 and 3, 2 and 3)
Specialty: Critical Care, Emergency Medicine, Neurology
ICD-10: ,