[40 years after the last polio epidemic. Postpolio syndrome as a cause of "weaning failure"].
About 80,000 polio survivors are still living 40 years after the last polio epidemics in Germany. Of these 40-70% have developed the so called post-polio syndrome (PPS) decades after the infection. The main symptoms of PPS are decreasing strength in voluntary muscles, pain and fatigue which occur spontaneously but may also be induced by physical stress and general illness. We report the case of a 79-year-old male who developed hypercapnia due to ventilatory failure which necessitated reintubation several times after cholecystectomy. The medical history revealed that he had had poliomyelitis at the age of 8 years. There was only a slight residual handicap from this infection which included mild pareses of the left limbs but had remained stable for about 70 years. Electromyography revealed signs of chronic neurogenic changes in muscles of the left upper limb as well as in the pectoralis major. The diagnostic criteria of a post-polio syndrome were fulfilled and other neuromuscular diseases were excluded. The patient could be discharged from intensive care only after treatment by intermittent positive pressure ventilation via a facial mask. This case report shows that even patients who have a mild handicap after poliomyelitis can develop weaning problems. A PPS can exacerbate with inclusion of respiratory muscles in critically ill patients.
Neurologische Klinik mit Poliklinik, Universität Erlangen-Nürnberg.
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Gaul
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Winterholler
D000368:Aged; D002763:Cholecystectomy; D004576:Electromyography; D006801:Humans; D006935:Hypercapnia / Q000209:etiology / Q000628:therapy; D008297:Male; D011183:Postoperative Complications / Q000503:physiopathology / Q000628:therapy; D016262:Postpoliomyelitis Syndrome / Q000503:physiopathology* / Q000628:therapy; D012132:Respiratory Muscles / Q000503:physiopathology; D017211:Treatment Failure; D015300:Ventilator Weaning