Critical Matters Critical Care of Neuromuscular Disorders
Jun 17, 2019
Dr. M. Kamran Athar, a neurointensivist at the Farber Institute for Neuroscience, dives deep into acute neuromuscular disorders like Guillain-Barré syndrome and myasthenia gravis. He discusses differential diagnostics and explains when to admit patients to the ICU based on respiratory and autonomic concerns. Unique insights include predicting respiratory failure in GBS and the role of immunotherapies versus corticosteroids. Athar also highlights the importance of patient dignity and effective decision-making in critical care.
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Systematic Differential For Acute Weakness
- Acute neuromuscular weakness has a broad differential that includes neuropathies, neuromuscular junction disorders, myopathies, motor neuron and brainstem/spinal causes.
- Use clinical pattern, reflexes, CSF, EMG, imaging and serology to narrow the diagnosis quickly.
Set ICU Criteria Early
- Admit to ICU for respiratory failure, severe bulbar dysfunction, or significant autonomic instability for close monitoring.
- Monitor respiratory function and airway protection proactively to prevent emergent deterioration.
GBS Is Heterogeneous With Prognostic Subtypes
- Guillain-Barré is an immune-mediated, usually post-infectious, heterogeneous acute polyneuropathy with demyelinating and axonal variants.
- Subtypes affect prognosis: axonal forms are more severe and recover slower than AIDP.
