Tetraplegia Caused by Critical Illness Polyneuropathy Superimposed on Diabetic Neuropathy: A Case Report

重症多發性神經病變合併糖尿病神經病變導致四肢癱瘓：病例報告

厲家珍(Chia-Chen Li) ； 謝仕福(Shih-Fu Hsieh) ； 林銘川(Ming-Chuan Lin) ； 黃鐘葦(Chung-Wei Huang) ； 洪怡珣(Yi-Shiung Horng)

《台灣復健醫學雜誌》 39卷4期 (2011/12) Pp. 239-246

https://doi.org/10.6315/2011.39(4)06

摘要

目的：報告一個重症多發性神經病變（critical illness polyneuropathy）合併糖尿病神經病變（diabeticneuropathy）的病例，並且強調急性急症後早期活動（early mobility）的重要性。方法：一位四十二歲男性有糖尿病多發性神經病變病史，因肝膿瘍引起敗血性休克後導致弛緩性四肢癱瘓合併呼吸衰竭，臨床表現及電學檢查結果疑似多發性神經病變急性惡化。因先前的多發性神經病變病史使得鑑別診斷更加複雜，因此我們安排一系列完整檢查來排除其他可能造成多發性神經病變的系統性或代謝性疾病，最後確診為重症多發性神經病變合併糖尿病神經病變。結果：經過六個月的復健，病人可以在監督下使用助行器行走，並且在部分協助下執行日常生活活動。但是他仍然表現肌肉無力，感覺異常，自主系統失調以及慢性失能。結論：重症的病人常發生重症多發性神經病變造成肢體無力，脫離呼吸器有所困難，並導致嚴重失能。早期診斷及預防對於減少此疾病發生率及住院花費相當重要。早期復健是安全而可行的介入方法，且可能改善急性急症臨床預後。

關鍵字

重症（critical illness） ； 多發性神經病變（polyneuropathy）

並列摘要

Objective: To describe a patient with the critical illness polyneuropathy superimposed on diabetic neuropathy and to highlight the importance of early rehabilitation after critical illness. Methods: A 42-year-old man with a previous history of diabetic polyneuropathy developed flaccid tetraplegia with respiratory failure after septic shock due to a liver abscess. This clinical manifestation, combined with the result of an electrodiagnostic study, suggested the acute exacerbation of polyneuropathy. Because a pre-existing polyneuropathy history complicated a differential diagnosis, we performed a comprehensive work-up to rule out other systemic diseases or metabolic disorders that may cause polyneuropathy. Finally, the diagnosis of critical illness polyneuropathy superimposed on diabetic neuropathy was established. Result: After 6 months of rehabilitation, the patient was able to ambulate with a walker under supervision and perform the activities of daily living with partial assistance. However, he still had muscle weakness, sensory impairment, autonomic dysfunction, and chronic disabilities. Conclusion: Critical illness polyneuropathy, resulting in limb weakness and difficulty in weaning from a ventilator, commonly occurs in critically ill patients and may cause severe disability. Early diagnosis and prevention of this condition are important to reduce the incidence and cost of hospital stays. Early rehabilitation can be a safe and feasible intervention and has the potential to improve clinical outcomes of critical illness.

並列關鍵字

critical illness ； polyneuropathy