title: A pediatric case of critical illness polyneuropathy: clinical and pathological findings.
abstract: Critical illness polyneuropathy (CIP) is a sensorimotor polyneuropathy recognized in adult intensive care patients with sepsis and multiple organ dysfunction and only a few cases have been reported in children. Here we report a 13-year-old Japanese boy with CIP that developed during the course of encephalopathy. Two months after the onset of encephalopathy, he developed tetraplegia although consciousness had already recovered. Deep tendon reflex was absent. MRI of the brain and spinal cord was normal and no abnormality in the cerebrospinal fluid was detected. Motor and sensory nerve conduction velocities of the lower limbs and somatosensory evoked potential could not be detected. The motor activity subsequently showed gradual recovery, although standing and walking could not be achieved. Sural nerve biopsy performed 3 years after the onset showed severe reduction of the number of myelinated large-diameter fibers, thin myelin in almost all fibers and cluster formation of myelinated small-diameter fibers, indicating primary axonal degeneration with regeneration. We report here for the first time the neuropathological changes in peripheral nerves during the chronic stage of CIP in children.
authors.affiliation: Department of Pediatrics, Institute of Clinical Medicine, University of Tsukuba, 1-1-1 Tennohdai, Tsukuba, Ibaraki 305-8575, Japan. tohto@md.tsukuba.ac.jp
authors.forename: Tatsuyuki
authors.initials: T
authors.lastname: Ohto
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Iwasaki
authors.forename: Norio
authors.initials: N
authors.lastname: Ohkoshi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Aoki
authors.forename: Mika
authors.initials: M
authors.lastname: Ichinohe
authors.forename: Ryuta
authors.initials: R
authors.lastname: Tanaka
authors.forename: Nobuko
authors.initials: N
authors.lastname: Moriyama
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ieshima
authors.forename: Katsuko
authors.initials: K
authors.lastname: Kuwajima
authors.forename: Akira
authors.initials: A
authors.lastname: Matsui
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D010525:Peripheral Nerves / Q000473:pathology; D011115:Polyneuropathies / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology