ON CALL - Acute Neuromuscular Disorders

Introduction

 Patients with severe neuromuscular weakness are commonly evaluated by the neurointensivist, both for admission to the neurointensive care unit and in consultation in other ICUs. While neurocritical care for acute neuromuscular disorders encompasses all aspects of patient care, issues regarding recognition and intervention for acute respiratory failure are the highest initial priority. Involvement of the muscles of respiration and/or severe bulbar weakness leading to neuromuscular respiratory failure can occur in some patients, and timely recognition and management can be lifesaving. This comprehensive overview of acute neuromuscular disorders is structured similarly to how the clinician might approach such a patient with regards to timing and stabilization, beginning with the pathophysiology, recognition, differential diagnosis, and management of neuromuscular respiratory failure. After ensuring cardiopulmonary stability, further management is tailored to the underlying diagnosis and its associated complications. Accordingly, subsequent sections of this review focus on the most common acute neuromuscular disorders encountered by the neurointensivist: Guillain-Barre syndrome (GBS), myasthenia gravis (MG), and critical illness neuromyopathy (CINM).